Arts, Faculty of
Social Work, School of
DSpace
UBCV
Morton, Betty Marie
Master of Social Work - MSW
University of British Columbia
This is an exploratory study of (a) material and (b) method, for analyzing the role of the male partner in marital conflict cases, and the casework implications of the involvement of the husband in the treatment process. For this purpose a small number of cases (15) from the files of the Family Service Agency of Greater Vancouver, were selected for intensive examination, and compared as three groups: (I) in which the casework treatment was focussed on the wife, (II) in which the casework treatment was focussed on the husband, and (III) in which casework was focussed equally on husband and wife. Methods of analysis and classification were worked out in the following areas; (1) the problems discussed by the marriage partners, (2) the performance of the husband in the masculine role, (3) the patterns of interrelationship between husband and wife, and (4) the casework treatability of each marriage partner. It was found, in all cases, that the male spouses were failing in the emotional areas of their roles, in their relationships with their wives and with their children. They were, generally, able to perform adequately as economic providers of the family, and to conform to social and cultural standards. All of the men disclosed a problem in handling their emotional dependency. Nearly three-quarters showed excessive dependence on their wives; the others were trying to handle their dependence in different, but still neurotic fashions. The background information about these men often indicated that their early relationships to their parents had been such as to prevent a healthy resolution of their oedipal feelings, resulting in weak masculine identification, or identification to a pathological pattern of masculine behaviour. In Groups I and II, where casework was focussed on one partner almost to the exclusion of the other, it was generally found that treatment had been focussed on the spouse who had applied first to the agency, and who had been interviewed by a caseworker of the same sex. The focus of treatment on one partner or the other was also clearly related to the relative willingness of the spouses to use casework service. In Group II in which the men were the focus of treatment, to the virtual exclusion of the wives, the men rated better in their performance in the masculine role than in Group I in which the reverse was the case. The treatment techniques used were found to be predominantly those of psychological support and clarification. Movement was measured by an adaptation of the Hunt-Kogan Movement Scale; and techniques described by Florence Hollis. In Groups I and II in which the focus was mainly on one partner, greater positive movement was achieved by this partner. In Group III, in which the treatment was focussed dually on husband and wife, the partners generally both achieved positive movement, to a similar degree. While some improvement in the marriage was seen to result from the positive movement achieved by one partner, generally, considerable improvement in the marriage seemed to result only when both partners achieved positive movement. No improvement occurred in one-fifth of the cases, there was some improvement in slightly less than half the cases, and considerable improvement in one-third of the cases. Some of the factors apparently influential in determining success or failure in these cases, are discussed.
THE PSYCHODYNAMICS AMD TREATMENT OF THE MALE PARTNER IN MARITAL CONFLICT CASES An Exploratory Study based on Family Service Agency F i l e s , Vancouver, 1957 by BETTY MARIE MORTON Thesis Submitted i n P a r t i a l Fulfilment of the Requirements f o r the Degree of MASTER OF SOCIAL WORK i n the School of S o c i a l Work Accepted as conforming to the standard required f o r the degree of Master of .Social Wofck School of So c i a l Work 1957 The University of B r i t i s h Columbia - V -ABSTRACT T h i s i s an e x p l o r a t o r y s t u d y o f (a) m a t e r i a l and (b) method, f o r a n a l y z i n g the r o l e o f t h e male p a r t n e r i n m a r i t a l c o n f l i c t c a s e s , and the casework i m p l i c a t i o n s o f t h e i n v o l v e m e n t o f the husband i n t h e t r e a t m e n t p r o c e s s . F o r t h i s purpose a s m a l l number o f cases (15) from t h e f i l e s o f t h e F a m i l y S e r v i c e Agency o f G r e a t e r Vancouver, were s e l e c t e d f o r i n t e n s i v e e x a m i n a t i o n , and compared as t h r e e groups: ( I ) i n w h i c h t h e casework t r e a t m e n t was f o c u s s e d on t h e w i f e , ( I I ) i n w h i c h t h e casework t r e a t m e n t was f o c u s s e d on t h e husband, and ( I I I ) i n w h i c h casework was f o c u s s e d e q u a l l y on husband and w i f e . Methods o f a n a l y s i s and c l a s s i f i c a t i o n were worked out i n t h e f o l l o w i n g a r e a s ; (1) the problems d i s c u s s e d by t h e m a r r i a g e p a r t n e r s , (2) t h e performance o f t h e husband i n t h e m a s c u l i n e r o l e , (3) t h e p a t t e r n s o f i n t e r r e l a t i o n s h i p between husband and w i f e , and (4) t h e casework t r e a t a b i l i t y o f each m a r r i a g e p a r t n e r . I t was f o u n d , i n a l l c a s e s , t h a t t h e male spouses were f a i l i n g i n the e m o t i o n a l a r e a s o f t h e i r r o l e s , i n t h e i r r e l a t i o n s h i p s w i t h t h e i r w i v e s and w i t h t h e i r c h i l d r e n . They were, g e n e r a l l y , a b l e t o p e r f o r m a d e q u a t e l y as economic p r o v i d e r s o f t h e f a m i l y , and t o conform t o s o c i a l and c u l t u r a l s t a n d a r d s . A l l o f the men d i s c l o s e d a problem i n h a n d l i n g t h e i r e m o t i o n a l dependency. N e a r l y t h r e e - q u a r t e r s showed e x c e s s i v e dependence on t h e i r w i v e s ; t h e o t h e r s were t r y i n g t o h a n d l e t h e i r dependence i n d i f f e r e n t , but s t i l l n e u r o t i c f a s h i o n s . The background i n f o r m a t i o n about t h e s e men o f t e n i n d i c a t e d t h a t t h e i r e a r l y r e l a t i o n s h i p s t o t h e i r p a r e n t s had been such as t o p r e v e n t a h e a l t h y r e s o l u t i o n o f t h e i r o e d i p a l f e e l i n g s , r e s u l t i n g i n weak m a s c u l i n e i d e n t i f i c a t i o n , o r i d e n t i f i c a t i o n t o a p a t h o l o g i c a l p a t t e r n o f m a s c u l i n e b e h a v i o u r . I n Groups I and I I , where casework was f o c u s s e d on one p a r t n e r a l m o s t t o t h e e x c l u s i o n o f the o t h e r , i t was g e n e r a l l y found t h a t t r e a t m e n t had been f o c u s s e d on t h e spouse who had a p p l i e d f i r s t t o t h e agency, and who had been i n t e r v i e w e d by a caseworker o f t h e same s e x . The f o c u s o f t r e a t m e n t on one p a r t n e r o r t h e o t h e r was a l s o c l e a r l y r e l a t e d t o t h e r e l a t i v e w i l l i n g n e s s o f t h e spouses t o use casework s e r v i c e . I n Group I I i n w h i c h t h e men were t h e f o c u s o f t r e a t m e n t , t o t h e v i r t u a l e x c l u s i o n o f t h e w i v e s , t h e - v i -men r a t e d b e t t e r i n t h e i r performance i n the m a s c u l i n e r o l e t h a n i n Group I i n w h i c h t h e r e v e r s e was t h e c a s e . The t r e a t m e n t t e c h n i q u e s used were found t o be p r e d o m i n a n t l y those o f p s y c h o l o g i c a l s u p p o r t and c l a r i f i c a -t i o n . Movement was measured by an a d a p t a t i o n o f t h e Hunt-Kogan Movement S c a l e ; and t e c h n i q u e s d e s c r i b e d by F l o r e n c e H o l l i s . I n Groups I and I I i n w h i c h t h e f o c u s was m a i n l y on one p a r t n e r , g r e a t e r p o s i t i v e movement was a c h i e v e d by t h i s p a r t n e r . I n Group I I I , i n w h i c h t h e t r e a t m e n t was f o c u s s e d d u a l l y on husband and w i f e , t h e p a r t n e r s g e n e r a l l y b o t h a c h i e v e d p o s i t i v e movement, t o a s i m i l a r d e g r e e . W h i l e some improvement i n the m a r r i a g e was seen t o r e s u l t f r om t h e p o s i t i v e movement a c h i e v e d by one p a r t n e r , g e n e r a l l y , c o n s i d e r a b l e improvement i n t h e m a r r i a g e seemed t o r e s u l t o n l y when b o t h p a r t n e r s a c h i e v e d p o s i t i v e movement. No improvement o c c u r r e d i n o n e - f i f t h o f t h e c a s e s , t h e r e was some improvement i n s l i g h t l y l e s s t h a n h a l f t h e c a s e s , and c o n s i d e r a b l e improvement i n o n e - t h i r d o f t h e c a s e s . Some of t h e f a c t o r s a p p a r e n t l y i n f l u e n t i a l i n d e t e r m i n i n g s u c c e s s or f a i l u r e i n t h e s e c a s e s , a r e d i s c u s s e d . In presenting t h i s thesis i n p a r t i a l fulfilment of the requirements f o r an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the Head of my Department or by his representative. It i s understood that copying or publication of t h i s thesis f o r f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of The University of B r i t i s h Columbia, Vancouver 8, Canada. Date / - v i i -ACKNOWLEDGEMENTS I w i s h to.acknowledge the v a l u a b l e a s s i s t a n c e i n w r i t i n g t h i s t h e s i s g i v e n t o me by Dr. Leonard Marsh and Mrs. H e l e n Exner o f t h e S c h o o l o f S o c i a l Work o f t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , b o t h o f whom gave g e n e r o u s l y o f t h e i r t ime and knowledge. Mr. Deryck Thomson, D i r e c t o r o f t h e F a m i l y S e r v i c e Agency o f G r e a t e r Vancouver gave h i s f u l l c o - o p e r a t i o n ; h i s encouragement and h e l p f u l n e s s i s v e r y much a p p r e c i a t e d . I am g r a t e f u l a l s o , f o r t h e k i n d i n t e r e s t o f my c o l l e a g u e s on the s t a f f o f t h i s agency, who gave me e v e r y a s s i s t a n c e p o s s i b l e . - i i TABLE OF CONTENTS Chapter 1. Preliminary Examination of the Problem and i t s Setting Page Definition of marital conflict. Causes: social and cultural, environmental, individual emotional maturity. The health of the marital relationship. How the caseworker helps. The role of the Family Service Agency i n Treatment. Focus of this study. Methodology 1 Chapter 2. Diagnosis in Marital Conflict Cases The task of diagnosis. Problems discussed by the marriage partners. The masculine role: definition and c r i t e r i a . Application of c r i t e r i a ; rating of cases; discussion of groups. Illustrative cases. The learning of the masculine role. Illustrative cases. Marital interrelationships; excessive dependency; patterns of disturbed inter-relationships. Illustrative cases 24 Chapter 3 . Process: Assessment of Treatability and Treatment Methods Criteria selected to assess treatability. Definition of ego strength. Application of c r i t e r i a to cases. Discussion of group ratings. Treatment methods defined. Case illustrations 68 Chapter 4. Movement in Marital Conflict Cases Definition and measurement of individual movement. Assessment of improvement in the marriage. Representative examples from case material. Discussion of movement, by groups. Factors influencing movement. Suggestions from a comparable study 92 Chapter 5 . Marital Conflict: An Exploration of Treatment-Assessment Methods Areas in which male partners f a i l . Some casework implications; assignment of caseworkers; "timing"; treatability. Need for continued research. . 122 Appendix Bibliography - i i i -LIST OF TABLES To follow page Table 1. T o t a l Number and C l a s s i f i c a t i o n of Problems Referred to by C l i e n t s , i n Intake Interviews. Comparison of Groups I-III 30; • Table 2. Rating of the F i f t e e n Men i n Regard to t h e i r Performance i n the Masculine Role (based on Schedule 4) . . 36; Table 3. Assessment of Casework T r e a t a b i l i t y of Marriage Partners 74 -Table 4. Cases regrouped According to the Degree of Movement. (Based on Schedule 8) 109 -i v LIST OF SCHEDULES Page Schedule 1. Patterns of Problems Presented by C l i e n t s , i n Intake Interview, Group I (cases A,B,C,D,E) 28 Schedule 2. Patterns of Problems Presented by Clien t s i n Intake Interview, Group II (cases F,G,H,I,J) 29 Schedule 3« Patterns of Problems Presented by Clients i n Intake Interview, Group III (cases K,L,M,N,0) 30 Schedule 4. Some Suggested C r i t e r i a for Evaluation of Performance i n the Masculine Role . . 36 Schedule 5« Patterns of M a r i t a l Inter-relationships . . . . . . . . 54 Schedule 6. Suggested C r i t e r i a f o r Evaluation of T r e a t a b i l i t y 74 Schedule 7. Treatment Techniques 89 Schedule 8. Movement and Improvement i n the Marriage * 108 THE PSYCHODYNAMICS AND TREATMENT OF THE MALE PARTNER IN MARITAL CONFLICT CASES An Exploratory Study based on Family Service Agency F i l e s , Vancouver, 1957 CHAPTER 1 PRELIMINARY EXAMINATION OF THE PROBLEM AND ITS SETTING The amelioration of marital c o n f l i c t problems seems to be a subject of popular concern. The lay p u b l i c , as w e l l as most of the professions, are increasingly aware of the wide incidence of such problems, but also that they have causes which can be treated. The concern i s a v i v i d one because the I n s t i t u t i o n s of marriage and family group l i v i n g are v i t a l i n Western culture. M a r i t a l c o n f l i c t moreover, can be seen as a self-perpetuating phenomenon, with the chil d r e n of unhappy marriages coming to maturity and marrying with a decreased chance of a successful adjustment. As the existence of such problems becomes accepted, the stigma attached to asking for help with them wanes. Thus many professions, not p r i m a r i l y concerned with s o c i a l problems, as such, are often consulted f o r "marriage counselling." The clergy, lawyers, doctors, and even employers, each see the problem from a d i f f e r e n t point of view and, usually, t r y to help i n t h e i r own way. The solutions sought by two people joined i n an unhappy, unsatisfying marital relationship are varied. Some seek redress from the law f o r wrongs they f e e l they have suffered at t h e i r partner's hands; some retreat from the c o n f l i c t by developing psychogenic i l l n e s s e s . When t h i s underlying factor of marital c o n f l i c t becomes apparent to the doctor or to the lawyer, he may endeavour to help with t h i s problem himself, or as i n many eases, r e f e r the patient or c l i e n t to what he considers a more appropriate source of help. S o c i o l o g i s t s , psychologists, p s y c h i a t r i s t s and s o c i a l workers, more s p e c i f i c a l l y concerned with the problem of marital discord, s t i l l d i f f e r i n t h e i r views concerning causation and treatment. No one profession can claim to have the only v a l i d approach, and i t i s only by d i s c i p l i n e d exploration by a l l groups, with sharing of the knowledge gained, that the most complete understanding of the problem can be reached. What i s a M a r i t a l C o n f l i c t Case? Mar i t a l c o n f l i c t , per se, i s sometimes d i f f i c u l t to i d e n t i f y as i t can appear under many guises. For example: the family disequilibrium may be, apparently, due to the disturbed or delinquent behaviour of one of the children, which i s the r e s u l t of the mother's r e j e c t i o n of him. Further exploration may show that the mother's r e j e c t i o n of the c h i l d stems from her r e j e c t i o n of her husband, the c h i l d ' s father. A family may appear to be i n economic d i f f i c u l t i e s because the father cannot hold his job. But t h i s may be due to a marital r e l a t i o n -ship which has robbed him of confidence i n himself, raised h i s anxiety to such a p i t c h that he cannot apply himself to the work s i t u a t i o n . He may i n f a c t be using t h i s method of r e t a l i a t i n g against his wife. Because a marriage represents a family, whether or not there are children, the two categories of "family problem" and "marital c o n f l i c t problem" are d i f f i c u l t to delineate. The ramifications of a marital problem usually are extended to include a l l members of the group. Family casework has been defined as, "Casework based on an understanding of the s o c i a l , p h y s i c a l , and emotional needs of the family, as a un i t , f o r the purpose of helping the family members a t t a i n the best 1 personal and s o c i a l s a t i s f a c t i o n s of which they are capable." Marriage counselling, on the other hand, has been defined as, "A s p e c i a l i z e d f i e l d of family counselling which centres l a r g e l y on the inter-personal r e l a t i o n s h i p between husband 2 and wife." In the broad sense however, a l l cases are usually categorized as marital c o n f l i c t cases when either of the marriage partners asks for help on the basis that t h e i r marriage i s unsatisfying. While the patterns of expressing marital discord are legion, Dr. Nathan W. Ackerman points out that disturbances of the marriage r e l a t i o n s h i p are character-ized by two s a l i e n t elements: (a) f a i l u r e of r e c i p r o c i t y of s a t i s f a c t i o n s , and (b) c o n f l i c t ; the c o n f l i c t bearing, usually, a s p e c i f i c r e l a t i o n s h i p to the f a i l u r e of r e c i p r o c i t y 1 Scherz, Frances H., "What i s Family Centered Casework?" S o c i a l Casework. Vol. XXXIV, No. 8 (October 1953), P« 3*3. 2 Hanford, Jeanette, "The Place of the Family Service Agency i n M a r i t a l Counselling," S o c i a l Casework. Vol. XXXIV, No. 6 (June 1953)> P. 24?. 1 i n the r e l a t i o n s h i p . How Does Ma r i t a l C o n f l i c t Arise? The causes of marital c o n f l i c t are somewhat more e a s i l y reviewed i f three areas are distinguished; a) s o c i a l and c u l t u r a l ; b) environmental; and c) i n d i v i d u a l emotional maturity. a) S o c i a l and C u l t u r a l In North America and Western Europe, i n the l a s t one hundred and f i f t y years, there have been a variety of economic and technological changes—with great s o c i a l consequence. The impact of these changes on the family group, has caused changes i n the c h a r a c t e r i s t i c roles of husband and wife. With increasing i n d u s t r i a l i z a t i o n , the father of the family spends most of h i s time out of the home, i n an e f f o r t to provide adequately f o r h i s wife and c h i l d r e n . Dr. Spurgeon 0 . English points out: The psychological r o l e of the father i n our society has been hard to grasp. Just as h i s s o c i a l r o l e has been continually changing, so h i s psychological r o l e assumes new forms as customs, b e l i e f s , thoughts and knowledge change . . . . In the past there were more r u r a l families i n which circumstances made Father more of a tangible, l i v i n g e n t i t y i n the home. Children who spent so much time with father were able to form from him, a d e f i n i t e image of how a father should behave . . . . He was a p o s i t i v e (even though stern) influence i n shaping h i s children's p e r s o n a l i t i e s . He knew h i s family as people, as in d i v i d u a l s with t h e i r l i m i t a t i o n s , accomplishments, needs and 1 Ackerman, Nathan W., "The Diagnosis of Neurotic M a r i t a l Interaction, 1" S o c i a l Casework. Vol . XXXV, No. 4 ( A p r i l 1954), p. 141. a b i l i t i e s . Modern urban l i f e has changed t h i s . I t would seem then, that our changing culture has tended to fragment family l i f e . 1 S i m i l a r l y , the ro l e of the wife and mother has experienced changes i n values. No longer i s the only s o c i a l l y acceptable pattern that of a submissive wife devoting he r s e l f to the home. With her emancipation from the V i c t o r i a n concepts of femininity, woman gained the r i g h t to a divergency of acceptable r o l e s that seems to have proven a hazard to her successful adjust-ment i n marriage. In addition to the increased d i f f i c u l t i e s i n assuming t h e i r respective roles as husband and wife, the s o c i a l pressures to continue the a l l i a n c e are not as great as they once were. "With the loss of the old assurance that a marriage must continue f o r better or worse, a sense of 2 s t a b i l i t y has disappeared." b) Environmental The term "environment" can be interpreted not only i n a physical sense, but In an emotional sense a l s o . That I s , the q u a l i t y of a person's relationships to the people around him must be considered, and the degree to which these r e l a t i o n -ships s a t i s f y , f r u s t r a t e or place him i n c o n f l i c t . In case-work treatment the problem i s always to understand the 1 English, Spurgeon 0 . , "The Psychological Role of the Father i n the Family," S o c i a l Casework. Vol. XXXV (October 1954) , P. 323. 2 Hanford, i o c . c i t . - 6 -i n d i v i d u a l as he int e r a c t s with h i s p a r t i c u l a r environment with i t s c u l t u r a l over-tones. Much of the environment can he "selected* 1 and the wisdom with which a person selects f o r h i s own well-being, i s often determined by h i s own emotional health and maturity. Thus an external problem i s often either overcome or perpetu-ated by the i n t e r n a l motivating forces i n the i n d i v i d u a l . Appropriate weight must be given by the caseworker to the environmental or external factors which are having an impact on the i n d i v i d u a l and he must be able to determine to what degree they have exacerbated emotional problems. In some cases the environment i s benign, i n others c r i p p l i n g . Under the stress of external events a new marital balance may have to eome into being. For example, to a young married couple, the b i r t h of the f i r s t c h i l d demands some changes i n t h e i r way of r e l a t i n g to each other. Again, i f the male partner suffers a severe d i s a b i l i t y , the r o l e of the female partner may have to change from feminine p a s s i v i t y to that of the bread-winner• In most cases the external factor causing the d i s -equilibrium cannot be so e a s i l y delineated, as i t i s multiple. Even then, i t i s not only the f a c t of the existence of troubling external factors that must be considered, but t h e i r meaning and eff e c t on the indiv i d u a l s concerned, and on the marital balance between them. Thus two well adjusted people with a secure, mature marital r e l a t i o n s h i p can successfully weather - 7 -many of the exigencies of l i f e , while others are unable to conquer and survive r e l a t i v e l y normal or minor ones, because of t h e i r already precarious adjustment to l i f e . I t seems to be i n part, the adaptive powers or r e l a t i v e maturity of the personality that determine the disabling e f f e c t of external events on the personality structure. Then too, the strengths of a married couple are not just the strengths of t h e i r i n d i v i d u a l p e r s o n a l i t i e s . They may be made weaker or stronger by the marriage r e l a t i o n s h i p , according to i t s q u a l i t y . c) Individual Emotional Maturity That school of casework, to which t h i s study i s oriented, known as the "dynamic" school, follows i n i t s conceptions of the structure and development, of the person-a l i t y , the teachings of Freud, and the neo-Freudian sehool. Freud conceived of two i n s t i n c t i v e motivating forces being basic to the personality. These two forces, opposing i n nature, were designated as the e r o t i c or l i b i d i n a l and the aggressive or death i n s t i n c t . Both were considered to be co-existent with l i f e ; the purpose of the l i b i d i n a l d rive being that of maintaining the l i f e of the i n d i v i d u a l and to create and maintain the l i f e of the species. The purpose of the death drive was conceived as being that of reducing the complex l i v i n g organism to simpler, inorganic ones. Accepting the f a c t of t h i s i n t e r n a l s t r i f e , the i n d i v i d u a l can then be conceived as being constantly engaged i n a war on two fron t s ; - 8 -i n t e r n a l l y at c o n f l i c t between h i s two i n s t i n c t u a l d r i v e s , and externally i n c o n f l i c t with the environment to which he must adjust. These two primary forces are thought of as being present i n the i n d i v i d u a l from h i s b i r t h to h i s death and exis t i n g i n that part of the personality structure, as postulated by Freud, known as the i d . The simple, s t r a i g h t -forward expression of these drives i s prevented by the super-ego or "conscience 1* which represents the rules f o r l i v i n g incorporated from the parents and l a t e r from the c u l t u r e . In terms of Freudian analysis, mediating between the demands of the i d f o r expression and the superego f o r co n t r o l , i s the t h i r d part of the personality structure, the ego. Through the ego, and i t s mechanisms of defence, which are part of the ego, an i n d i v i d u a l adjusts himself to the environment and meets, as f a r as possible, the needs of h i s i n s t i n c t u a l d r i v e s . Through the ego, emotions, both p o s i t i v e and negative are experienced, and advantages and disadvantages gained. The ego i s conscious i n nature as opposed to the i d and superego which are unconscious. The ego develops as the i n d i v i d u a l grows from infancy to adulthood. As the c h i l d grows p h y s i c a l l y , so he grows emotionally, under normal conditions, that i s , h i s power to perceive r e a l i t y and to deal adequately with the environment increases. Miss H o l l i s points out: "the trans-mutation of the primitive i n s t i n c t u a l drives into the capacity f o r adult love relationships i s perhaps the most important of 1 these ego tasks." In the beginning the c h i l d i s concerned only with himself, and the g r a t i f i c a t i o n of h i s needs f o r food, warmth, and comfort. These things are provided, normally, through the mother. Her a b i l i t y to give to the infant i s , i n turn, dependent on the extent to which she had been given to by her own parents. As the c h i l d incorporates food from the mother he should also, i d e a l l y , incorporate her love. And so, mother's love becomes something of value, to be sought a f t e r by the c h i l d as he moves into the phase of being able to conceive of mother and himself as separate e n t i t i e s . Because of t h i s desire to r e t a i n mother's love, the c h i l d i s able to t r y to conform to the f i r s t s o c i a l demands that mother makes of him, during the t o i l e t t r a i n i n g period. He i s able to deny himself immediate release from tension, to withstand f r u s t r a t i o n , i n order to win her approval. In the next phase of emotional development, the c h i l d becomes aware of the d i f f e r e n t i a t i o n of the sexes—and becomes aware of h i s parents as being re l a t e d to each other i n a way that excludes him. The c h i l d , normally develops a strong love rel a t i o n s h i p to the parent of the opposite sex, with the desire to supplant the parent of the same sex. Gradually, 1 H o l l i s , Florence, Women i n M a r i t a l C o n f l i c t . Family Service Association, New York, 194-9, p. 14. 10 -however, he perceives that t h i s i s not possible and he learns to accept both the g r a t i f i c a t i o n s and f r u s t r a t i o n s of p a r t i a l love f o r the parent of the opposite sex, and i d e n t i f i c a t i o n with the parent of the same sex. Thus the l i t t l e boy-renounces h i s desire to possess mother completely and to supplant father, and resolves to become " l i k e father." This holds f o r t h the promise of adult g r a t i f i c a t i o n s . To accomplish t h i s l e v e l of performance, the adaptive powers of the ego have been developing through a l l three phases: the o r a l , anal and oedipal, as they were designated by Freud. In the mature i n d i v i d u a l then, there i s not only s e l f - l o v e but the a b i l i t y to love others and to express t h i s love appropriately, both i n q u a l i t y and degree. H o l l i s says, further, A mature marriage adjustment requires that he must have freed himself of strong c h i l d i s h parental attachments, that his s p e c i f i c sexual drives be directed towards the opposite sex, and that he be able t r u l y to perceive and care about the needs of his partner.1 While the primary i n s t i n c t u a l l i b i d i n a l drive i s thus being channelled toward a mature expression, the destructive drive i s also being harnessed and co n t r o l l e d . Some d i r e c t expression occurs i n the conquering of the environment. Some i s pushed into the unconscious portion of 1 L o c « c i t - l i -the mind by the mechanisms of defence such as repression. But some h o s t i l i t y must have been allowed expression, as such, p a r t i c u l a r l y i n childhood, i f the development of serious neurotic symptoms i s to be avoided. While no one i s completely free of neurotic tendencies, the degree to which the t o t a l adjustment i s n e u r o t i c a l l y determined, must be assessed i n treatment. The Health of the M a r i t a l Relationship To t h i s point the discussion has been focussed larg e l y on the development of the i n d i v i d u a l . As these individuals approach chronological maturity, most enter into a marital r e l a t i o n s h i p , which, at least at the out-set, i s believed, by them, to promise s a t i s f a c t i o n of emotional needs. The marriage r e l a t i o n s h i p i s an e n t i r e l y unique one. While most people expect marriage to better t h e i r l o t , and i n many cases i t does, conversely i n many marriages the opposite development occurs. Old problems may be exacerbated, new ones created, to such an extent that not only i s the marriage thrown into jeopardy, but the i n d i v i d u a l adjustments as w e l l . Dr. Nathan Ackerman points out that i n a neurotic marital r e l a t i o n s h i p the degree of neurosis present i s not simply the sum of the neuroses of the two indiv i d u a l s who joined i n the r e l a t i o n s h i p , as i t has been demonstrated that a given i n d i v i d u a l with a f i x e d neurosis w i l l i nter-aet i n s i g n i f i c a n t l y d i f f e r e n t ways with d i f f e r e n t partners. He - 12 -points out further, When the s p e c i f i c component of neurotic i n t e r - a c t i o n has been d i f f e r e n t i a t e d , a c a r e f u l estimate of the balance between the pathology and the r e s i d u a l health of the relationship i s of the utmost c l i n i c a l importance.! Thus i n diagnosis and treatment of marital c o n f l i c t , caseworkers are concerned not only with the r e l a t i v e emotional health of the i n d i v i d u a l s , per se, but also with the r e l a t i v e emotional health of the r e l a t i o n s h i p between them and the extent to which i t s a t i s f i e s t h e i r emotional needs. Some extremely neurotic relationships are very s a t i s f y i n g ones and the best adjustment that can be made by the two in d i v i d u a l s concerned. Thus, i n such cases, the goal may be to restore the balance i f i t has become jeopardized by some external force or event. In such r e l a t i o n s h i p s , the value to the indivi d u a l s seems to be that t h e i r defences against neurotic anxiety are protected by the other partner. Thus the "marital neurosis" holds t h e i r own i n d i v i d u a l neuroses i n e q u i l i b r i u m — which i s t h e i r prime concern. The i n d i v i d u a l neurotic adjustment i s e a s i l y threatened: a great deal of psychic energy must be devoted by the i n d i v i d u a l to i t s maintenance, i f he i s to survive. How the Caseworker Helps The caseworker approachs diagnosis and treatment of any problem by evaluating both the environmental and emotional 1 Ackerman, pj->. ci£., p. 139. - 13 -factors i n the development of the s i t u a t i o n i n which the c l i e n t or c l i e n t s f i n d themselves. The c l i e n t ' s readiness and a b i l i t y both to assess and to move, i n regard to his own problems, must be the determining factor i n deciding how f a r the treatment w i l l proceed, i n what d i r e c t i o n , and on what l e v e l . Treatment methods appropriate to each case are selected. Although the caseworker may be able to recognize the symptoms of problems that are more deeply rooted than those of which the c l i e n t i s aware, she does not attempt to e l i c i t conscious awareness of unconscious material from the c l i e n t . This l i e s beyond the s k i l l s of the caseworker, i n the province of the p s y c h i a t r i s t . Psychiatry has however, given caseworkers an understanding of the phenomena of ambivalence, resistance, and transference, with which the caseworker must be concerned. The caseworker deals only with " r e a l " problems, with the c l i e n t , that i s , problems that can be consciously recognized by the c l i e n t . Casework u t i l i z e s the c l i e n t ' s ego strengths. I f the c l i e n t ' s ego strengths are considerable, i f the c l i e n t i s ready and i f the s i t u a t i o n warrants i t , the caseworker may help the c l i e n t to c l a r i f y and/or to develop insight into h i s c h a r a c t e r i s t i c ways of reacting that are causing him d i f f i c u l t y and help him, within the framework of the supporting worker-client r e l a t i o n s h i p to change these patterns. In other s i t u a t i o n s , t h i s may not be a suitable goal and casework may be directed towards a - 14 -strengthening of c h a r a c t e r i s t i c patterns that are i n jeopardy. In s t i l l other cases, an "Environmental Approach" may be the most appropriate one. This treatment method foeusses on external problems and i n helping the c l i e n t to e f f e c t changes i n the external s i t u a t i o n . This may be done either d i r e c t l y , by intervention on the part of the caseworker, or through the c l i e n t ' s improved a b i l i t y to see what can be done and how to do i t to make himself more comfortable, and to move toward accomplishing t h i s . In most cases the treatment method cannot be c l e a r l y relegated to any one category, but contains elements of one or more of those outlined above. Basic to a l l treatment techniques however, i s the caseworker's s k i l l i n forming an enabling relationship with the c l i e n t , t a i l o r e d to a dynamic understanding of the c l i e n t ' s needs. In the treatment of marital c o n f l i c t cases, focus on the i n d i v i d u a l i s not enough. The caseworker must be constantly aware of the inter-play between the partners, and how change may be effected through and i n thi s i n t e r - p l a y , — she must be aware of how change on the part of one, af f e c t s the other. The goal may be defined as "the giving of help i n restoring or establishing a s a t i s f a c t o r y balance i n the marriage or i n helping the ind i v i d u a l s concerned to accept 1 that t h i s i s not possible." 1 Moore, Eleanor A., "Casework S k i l l s i n Marriage Counselling," S o c i a l Casework. Vol. XXXIV (June 1953), p. 253. - 15 -The Role of the Family Service Agency i n Treatment of M a r i t a l C o n f l i c t H i s t o r i c a l l y , the Family Service Agencies, which had t h e i r beginnings i n the Charity Organization Movement of 1869, have been interested i n the causes of family breakdown, rather than confining t h e i r work to the amelioration of the symptoms. Over the years they have been concerned with a multitude of family problems. One p s y c h i a t r i s t has c a l l e d the family service agency the "Half-way house between the community and 1 the p s y c h i a t r i s t . " The Family Service Agency of Greater Vancouver, which i s the source of the records used i n t h i s study, was estab-li s h e d i n 1928. . . . the c o n s t i t u t i o n stated c l e a r l y that t h i s agency was to be a non-sectarian charitable i n s t i t u t i o n supported by voluntary subscriptions. I ts objectives were to do family welfare work i n Greater Vancouver; to maintain a S o c i a l Service Exchange f o r a l l s o c i a l welfare organizations i n Greater Vancouver and the surrounding d i s t r i c t s ; and to do such other welfare work as the Executive might consider advisable.2 The casework c a r r i e d on by t h i s agency was affected, as i t was i n a l l private s o c i a l agencies, by two great s o c i a l upheavals—the depression of the 193^ 's and the Second World War 1939-1945. During these two periods casework had to be 1 Hanford, fip_. ci£., p. 251. 2 M i t c h e l l , Robert J.G., "The Family Welfare Bureau of Greater Vancouver," (unpublished Master's Thesis, The Uni v e r s i t y of B r i t i s h Columbia, Vancouver, B.C., 1952), p. 13. - 16 focussed around the emergent economic and physical problems. Since the war's end, the agency has had opportunity to pursue i t s study and practice of casework geared to socio-emotional problems, on an intensive basis. At the present time i t i s recognized by the community as the appropriate s o c i a l agency for r e f e r r a l of marital c o n f l i c t problems. During the twenty-nine years since i t s inception, the agency s t a f f has increased from one person to a casework s t a f f of eighteen members. The standards f o r the s e l e c t i o n of personnel are high, and while some of the s t a f f members do not possess f u l l y accredited s o c i a l work t r a i n i n g , they are, on the other hand, possessed of a long period of casework practice i n the area of family casework. The s t a f f p a r t i c i p a t e s a c t i v e l y i n the planning and carrying out of a s t a f f development program, and opportunities are provided f o r the s t a f f to attend i n s t i t u t e s and seminars that help to keep practice abreast of new theory. While, at the present time, there i s no one p s y c h i a t r i c consultant, p r o v i s i o n has been made f o r the u t i l i z a t i o n of the services of any one of several p s y c h i a t r i s t s i n the c i t y , i n those cases where t h i s i s deemed necessary to c l a r i f y diagnosis and treatment. Referrals to the Family Service Agency of Greater Vancouver come from many sources. About f i f t y per cent of the cases i n 1956 were r e f e r r a l s from lawyers, doctors, businessmen, elergy, teachers and other s o c i a l agencies. The other f i f t y per cent were "personal a p p l i c a t i o n s " — t h a t i s , people - 17 -requesting help f o r themselves, d i r e c t l y from the agency. This figure tends to be misleading however, as there i s no way of knowing how many came as a r e s u l t of the agency's broad program of i n t e r p r e t a t i o n to the public or how many were, i n f a c t , advised to come by a member of one of the above groups. The requests are fo r help with a wide range of problems. The agency groups these under the following headings for s t a t i s t i c a l purposes. 1. Family Relationships a. M a r i t a l D i f f i c u l t y b. Parent-child relationships c. Unmarried Parenthood d. Other 2. Individual Personality Adjustment a. Children (under 13 years) b. Adolescents (13 through 20 years) c. Adults (21 and over) 3. Planning substitute care of children 4 . Old age 5. Physical i l l n e s s or handicap 6. Mental i l l n e s s (a) diagnosed (b) suspected . I n t e l l e c t u a l Retardation (a) diagnosed (b) suspected . Economic 9. Employment 10. Educational and Vocational adjustment 11. Recreation 12. Housing 13. Other In the year 1955» & t o t a l of 1,189 cases were closed i n the category "Family Relationships Problems," by t h i s agency. This category broke down as follows: M a r i t a l D i f f i c u l t i e s 80J> Parent C h i l d Relationships 270 Unmarried Parenthood 67 Other 39 The extremely high proportion of cases In which marital d i f f i c u l t y underlies the disturbed family - 18 -c o n s t e l l a t i o n s , i s at once evident. Of these 805 cases of marital d i f f i c u l t y , roughly f i f t y per cent were " b r i e f service" cases; that i s , those with less than two d i r e c t client-worker interviews. Some exploration of the causes of th i s early loss of cases might p r o f i t a b l y be undertaken. Undoubtedly part of t h i s number represents those people who are only t e n t a t i v e l y motivated towards seeking help with t h e i r problem. P a r t i c u l a r Focus of t h i s Study This study, which i s exploratory, i s concerned, p a r t i c u l a r l y , with the treatment of the male partner i n the casework treatment of marital c o n f l i c t cases. An i n t e r e s t and concern with t h i s question of t r e a t -ment of the male partner, i n marital counselling cases, i s frequently expressed by the casework s t a f f of the Family Service Agency, where t h i s study was ca r r i e d out. This seems to be part of a trend throughout agencies engaged i n t h i s area 1 of casework, generally. Opinions as to whether the casework involvement of both spouses, i n the treatment of marital c o n f l i c t i s desirable, i n a l l cases, d i f f e r s . The functional school of thought emphasizes the need to deal with both the husband and wife. Frances H , Scherz sayss "When one partner indicates that the marital r e l a t i o n s h i p i s the major factor i n the 1 Lake Wilderness I n s t i t u t e , F.S.A.A., 1955. - 19 -family's problems, the other partner should be seen as quickly as can be appropriately planned, i n order to Increase our 1 understanding of family i n t e r - a c t i o n . " The approach of the dynamic school of thought, to which t h i s study i s oriented, d i f f e r s . Having seen the f i r s t c l i e n t withdraw, a f t e r the spouse has been successfully involved, many questions about t h i s aspect seem to warrant scrutiny. F r i t z Schmidl points out that while i n some cases i t i s d i a g n o s t i c a l l y h e l p f u l to 2 see the spouse, i t can also be destructive to therapy. This study cannot attempt to provide answers to the questions that are being raised i n t h i s area, but w i l l attempt to i l l u s t r a t e what those questions are, the need to consider them and the extent to which t h i s was done i n the selected cases with which t h i s study deals. These questions include; 1) What sort of problems are experienced by the male partner i n marital c o n f l i c t cases? 2) What i s the r o l e of the husband i n the family group? 3) What are the patterns of i n t e r r e l a t i o n s h i p s evident between husbands and wives i n marital c o n f l i c t cases? 1 Scherz, Frances H., "What i s Family-Centered Casework?" S o c i a l Casework. Vo l . XXXIV (October 1953), P» 344. 2 Schmidl, F r i t z , "On Contact with the Second Partner i n Marriage Counseling," Journal of S o c i a l Casework. Vol. XXX, No. 1, January 1949, p. 35. - 2 0 4) Can a personality pattern be delineated i n those men who seek help from an agency i n regard to t h e i r marital problem? 5) How does movement compare, i n those cases where the treatment focus was p r i m a r i l y on the husband, p r i m a r i l y on the wife, and those cases i n which both partners p a r t i c i p a t e d equally i n treatment? 6) Is there any r e l a t i o n s h i p between the focus of t r e a t -ment on the husband, and the f a c t of who f i r s t applies to the agency; husband or wife? 7) Is there any rela t i o n s h i p between the focus of t r e a t -ment on either partner and the sex of the worker? 8) How and when are contacts with the husband planned, i n those cases where the wife applied f i r s t f o r casework service? Selection of Cases f o r t h i s Study F i f t e e n cases were selected f o r t h i s study. The casework s t a f f were asked to submit cases which contained enough diagnostic material i n regard to the male marital partner's personality, to allow f a i r l y d e t ailed a n a l y s i s . I t was explained that three d i f f e r e n t groups of cases were required; those i n which the main focus of treatment was on work with the wife, those i n which the main focus of treatment was on work with the husband, and those i n which the focus of treatment was shared dually by husband and wife. Of the cases submitted, f i v e were selected i n each group. The work of eight - 21 -caseworks; four men and four women i s represented. A l l of the cases were active i n either 1955 or 1956. One of the cases was opened i n 1953? ° n e was opened i n 1954, four were opened i n 1955 and nine were opened i n 1956. A l l of the cases were opened as marital c o n f l i c t cases, that i s the problem presented by the c l i e n t , i n the intake interview was marital d i f f i c u l t y and the request was f o r help, prim a r i l y , with t h i s . A l l of the families studied had c h i l d r e n . This was made one of the c r i t e r i a as a study of the male partner's r o l e i n the family group was to be undertaken, and normally, t h i s facet of h i s r o l e i s highly s i g n i f i c a n t . In each case, both marital partners had been i n t e r -viewed by the caseworker. This c r i t e r i a was applied so that diagnostic material i n regard to each marital partner's personality, and the nature of the r e l a t i o n s h i p between them, would be a v a i l a b l e . In average terms, the men i n these cases were around 38 years of age, with a range of 25-53 years. The average age of the wives was 34 years, with a range of 21-47 years. The average period of marriage was 8.6 years; the range, 4-25 years. The number of children was, on the average, four or f i v e . Methodology These f i f t e e n selected cases were studied by means of schedules, developed to assess each of the following areas; 1) Problems seen and presented by both partners i n the - 22 -Intake interview. This schedule shows the number and kind of problems seen by each partner and the extent to which they perceived t h e i r own contribution to the marital problem. 2) The performance of the husband i n the masculine r o l e . Five c r i t e r i a are suggested, and ratings of poor, l i m i t e d and good, described f o r each. 3) The i n t e r r e l a t i o n s h i p between the marriage partners. Five d i f f e r e n t patterns d i s c e r n i b l e i n these cases are described. 4) The casework t r e a t a b i l i t y of each marriage partner. Three c r i t e r i a were considered, and ratings of poor, l i m i t e d and good described i n regard to each. 5) Treatment techniques used with each marriage partner. 6) The degree of movement achieved by each partner. Movement achieved by each partner was measured by 1 the use of an adaptation of the Hunt and Kogan Movement Scale. Improvement i n the marital s i t u a t i o n was assessed by an adaptation of the method used by Florence H o l l i s i n her study 2 "Women i n Ma r i t a l C o n f l i c t . " I l l u s t r a t i v e case material i s given i n regard to each of these areas. These f i f t e e n cases are reviewed primarily for the purpose of distinguishing and discussing elements i n casework, 1 Hunt J . McV., and Kogan, Leonard, S., Measuring Results i n S o c i a l Casework. Family Service Association of America, 1950. 2 H o l l i s , op.. £l£. - 23 -the main concern being to explore what differences are ascertainable i n three d i f f e r e n t s i t u a t i o n s : (a) where the interviews are held, primarily with the wife (b) where the interviews are held primarily with the husband (c) where the interviews are held equally with husband and wife. For convenience the cases are named, (anonymously) as follows: Group I Group II Group I I I A. Able F. F e l l K. King B. Brown G. G r e n f e l l L. Long C. Crocker H. H a l l M. Manville D. Daniels I* Inman N. Nelson E\ Evans J . Jackson 0. Ggden Economic and environmental differences i n these cases are ignored, focussing attention on the psychodynamics of the i n d i v i d u a l s , and the rela t i o n s h i p between them. CHAPTER 2 DIAGNOSIS IN MARITAL CONFLICT CASES I n r e a c h i n g a d i a g n o s i s i n cases o f m a r i t a l c o n f l i c t , t h e caseworker i s concerned w i t h f a r more t h a n t h e problems a c t u a l l y p r e s e n t e d i n t h e f i r s t i n s t a n c e by the two m a r r i a g e p a r t n e r s . V ery o f t e n , t h e s e a r e but t h e symptoms o f t h e under-l y i n g c o n f l i c t a r e a s , and a r e o n l y o f s i g n i f i c a n c e as th e y a r e seen i n p e r s p e c t i v e w i t h t h e t o t a l r e l a t i o n s h i p . As i n most casework t h e aim i s t o o b t a i n a psychodynamlc e x p l a n a t i o n o f the s i t u a t i o n . Nathan Ackerman p o i n t s o u t : Of p a r t i c u l a r i m p o r t a n c e i s t h e need t o e v a l u a t e p a t h o l o g y o f i n d i v i d u a l p e r s o n a l i t y n o t i n i s o l a t i o n but w i t h i n t h e frame o f t h e p s y c h o s o c i a l s t r u c t u r e o f th e f a m i l y , and t o e s t a b l i s h t h e s p e c i f i c dynamic r e l a t i o n s o f p e r s o n a l i t y and f a m i l y r o l e s . . . . I n u n d e r t a k i n g t o d i a g n o s e m a r i t a l r e l a t i o n s h i p s we a r e n o t concerned i n the f i r s t i n s t a n c e w i t h t h e autonomous f u n c t i o n s and p a t h o l o g y o f I n d i v i d u a l p e r s o n a l i t i e s , b u t r a t h e r w i t h the dynamics o f t h e r e l a t i o n s h i p , t h a t i s , w i t h the r e c i p r o c a l r o l e f u n c t i o n s t h a t d e f i n e t h e r e l a t i o n s o f husband and w i f e . l I n t h i s c h a p t e r , t h r e e a s p e c t s o f d i a g n o s i s a r e examined: t h e immediate problems seen o r p r e s e n t e d by each p a r t n e r ; t h e performance o f t h e husband i n t h e m a s c u l i n e r o l e ( w h i c h i t s e l f r e q u i r e s d e f i n i t i o n ) ; and t h e i n t e r r e l a t i o n s h i p between husband and w i f e , i n the f i f t e e n c a ses used i n t h i s s t u d y . 1 Ackerman, Nathan W., "The D i a g n o s i s o f N e u r o t i c M a r i t a l I n t e r a c t i o n , " S o c i a l Casework. V o l . XXXV, No. 4 ( A p r i l 1954) , P. 139. - 25 -Problems Discussed by the Marriage Partners Anyone who applies to a s o c i a l agency f o r help, does so because he has reached an impasse i n regard to a problem i n adjustment. In some cases, the emotional component can be r e l a t i v e l y s l i g h t , but when the c l i e n t seeks help with hi s marital rel a t i o n s h i p a great deal of emotion i s usually present. Because the problem i s such an intimate one, h i s defences have been marshalled against the anxiety engendered by his marital c o n f l i c t , and he w i l l probably, because of t h i s , present a distorted view of the s i t u a t i o n . Regina Flesch points out, "The most p r o f i t a b l e i n i t i a l approach f o r the caseworker i s to treat the complaints as r e a l u n t i l the 1 c l i e n t himself proves them otherwise." Only when the case-worker has helped the c l i e n t by r e l i e v i n g the feelings of anger, pain and g u i l t , i s the c l i e n t free to look at h i s s i t u a t i o n more objecti v e l y and to move towards the d i s s o l u t i o n of his problems. In order to face the experience of asking f o r help, he may have selected only a part of the problem, which he f e e l s i s more acceptable for discussion, u n t i l he has been able to test out the reception he gets from the case-worker. He may present the problems as being rooted t o t a l l y i n h i s partner's personality and performance, or, t o t a l l y i n hi s own, i f he f e e l s t h i s w i l l better assure him recognition. He may come to the agency wanting only a sympathetic l i s t e n e r , 1 Flesch, Regina, "The Problem of Diagnosis i n M a r i t a l Discord," Journal of S o c i a l Casework. Vol. XXX, No. 9 (November 1949) , p. 361 . - 2 6 -he may seek an authority who w i l l " t e l l him what to do," or one who w i l l miraculously change h i s wife to meet h i s needs. In whatever way the problem i s presented, i t i s the caseworker's task to assess whether th i s i s part of the problem or a l l of i t ; whether i t i s r e a l or imaginary; and whether or not treatment i s possible. There i s no d e f i n i t e d i v i d i n g l i n e between diagnosis and treatment of the problem. As the caseworker seeks to a r r i v e at a psychodynamic reconstruction of the c l i e n t ' s s i t u a t i o n , considerable emotional material i s e l i c i t e d , v e n t i l a t e d , and the i n t e r -r e l a t i o n s h i p s of cause and e f f e c t may become apparent to the c l i e n t , as t h i s process proceeds. The caseworker i s seeking to learn how and why the marital problem arose, what past and previous factors contributed to i t , and to what extent the marital c o n f l i c t i s related to the i n d i v i d u a l c o n f l i c t i n each partner. The degree to whieh the caseworker and c l i e n t become mutually aware of the r e a l i t y s i t u a t i o n , varies from case to case. The c l i e n t ' s view of the problem may remain extremely s u p e r f i c i a l , or i t may deepen and become c l a r i f i e d , approaching the caseworker's conception of the contributing and underlying f a c t o r s . This depends not only on the nature of the problem and the kind of treatment required, but on the c l i e n t ' s capacity f o r i n s i g h t . In t h i s study each case was examined to determine the problems as seen and presented by husband and wife, In the - 27 -intake interview. A schedule which summarizes the patterns of problems i s presented f o r each of the three groups on the following three pages. In Group I, that i s , those cases i n which treatment was focussed mainly on the wife, i t can r e a d i l y be seen that the wives were apparently able to perceive a larger number of problems, and also problems of a more diverse nature than were the husbands. In t h i s group, the f i v e husbands perceived a t o t a l of nineteen problems, and located these i n the emotional and socio-economic areas. These problems were seen as being the r e s u l t of the wives* personality and performance. That i s , these men were not able to see, or to admit t h e i r own involve-ment i n the evolution of the problem, and saw therefore, the need to change the s i t u a t i o n as being t o t a l l y the wives' responsi-b i l i t y . These f i v e wives, on the other hand, saw a t o t a l of t h i r t y - s i x problems, located these i n the main i n the emotional and socio-economic areas but also saw problems occurring i n the areas of physical health, promiscuity, and alcoholism. While most of these problems were seen by the wives as at t r i b u t a b l e to t h e i r husbands* i n each case, they were able to admit to a degree of personal involvement. In Group I I , that i s , the f i v e cases i n which t r e a t -ment was mainly focussed on the husband, the s i t u a t i o n i s reversed. These f i v e men discussed a t o t a l of t h i r t y problems, locating them, again, mainly i n the emotional and socio-economic areas, but also In the areas of physical - 28 -Schedule 1. Patterns of Problems Presented by C l i e n t s . In Intake Interview Group 1. (cases A,B,C,D,E) ^ Problem Units Seen and Presented By Husband Wife (a) Emotional 1. M arital Relationship i . wife's attitude to husband A,B,E A,E i i . husband's attitude to wife A,B,C,D i i i . wife's sexual performance A,B,E E Iv. husband's sexual performance A,D,E 2. Emotional Health i . wife's emotional health D B,E 11. husband's emotional health B,D 3. Parental Relationships i . wife to childr e n D,E C,E i i . husband to children A,B,C,D,E 4. Interference from Relatives i . wife's family i i . husband's family 5. Emotional Health of Children C C,D (b) Intelligence 1. I n t e l l e c t u a l Retardation i . of wife i i . of husband i i i . of chi l d r e n (c) Physical Health 1. Physical Health I. of wife D i i . of husband B i i i . of children (d) Promiscuity i . of wife i i . of husband A,B,D (e) Alcoholism i . of wife i i . of husband D (f) Socio-Economic 1. Employment A A 1. of wife i i . of husband 2. Income C 1 3. Management of Income ! " 1. by wife B,D,E A i i . by husband C,E 4. S o c i a l Status i . of wife A i i . of husband 5". S o c i a l Behaviour i . of wife A,D,E i i i . of husband E ; 6. Housing 7. C u l t u r a l Differences B ' p. Religious Differences C Average number of problems i 3.8 per case 7.2 per case - 29 -Schedule 2 . Patterns of Problems Presented by C l i e n t s . In Intake Interview Group I I . (cases F,G,H,I,J) Problem Units Seen and Presented By WTf e ~ Husband (a) (b) (c) (d) (e) (f) Emotional 1. Marital Relationship i . wife's attitude to husband i i . husband's attitude to wife i i i . wife's sexual performance i v . husband's sexual performance 2 . Emotional Health wife's emotional health husband's emotional health 1. i i . 3. Parental Relationships i . wife to children i i . husband to children 4. Interference from Relatives 1. wife's family i i . husband's family 5. Emotional Health of Children Intelligence 1. I n t e l l e c t u a l Retardation i . of wife i i . of husband i i i . of childr e n Physical Health 1. Physical Health i . of wife i i . of husband i i i . of* children Promiscuity 1. of wife i i . of husband Alcoholism i . of wife i i . of husband Socio-Economic 1. Employment I. of wife 11. of husband 2 . Income 3. Management of Income 1. by wife i i . by husband 4. S o c i a l Status i . of wife i i . of husband 5. S o c i a l Behaviour i . of wife i i . of husband 6. Housing 7. Cultural Differences 8. Religious Differences FjGjH,IyJ F,H H,I,J H,J F,G,I,J G,H,I J J G,I F,G F F,G I H F F F,J ,H,J H G H,J F,G,H Average number of problems 6 per case 3-6 per case - 30 -Schedule 3. Patterns of Problems Presented by C l i e n t s , i n Intake Interview Group I I I . (cases K,L,M,N,0) Problem Units Husband I Wife (a) Emotional 1. M a r i t a l Relationship i . Wife's at t i t u d e to husband L,M,N i i . husband's att i t u d e to wife K,0 i i i . wife's sexual performance L,F i v . husband's sexual performance 2. Emotional Health 1. wife's emotional health 0 i i . husband's emotional health K,N 3. Parental Relationships j i . wife to c h i l d r e n M,0 i i . husband to children j 4 . Interference from Relatives i i . wife's family j i i . husband's family j N 5. Emotional Health of Children j (b) Intelligence j 1. I n t e l l e c t u a l Retardation j i . of wife i i . of husband i i i . of children (c) Physical Health 1. Physical Health { i . of wife I i i . of husband ! i i i . of children I (d) Promiscuity I i . of wife 1 i i . of husband | (e) Alcoholism \ i . of wife f i i . of husband S (f) Socio-Eeonomic I 1. Employment I 1. of wife I i i . of husband j K 2. Income \ N 3. Management of Income f I. by wife \ i i . by husband I 4 . S o c i a l Status f i . of wife I i i . of husband | 5. S o c i a l Behaviour I i . of wife I K,0 i i . of husband | 6. Housing I N 7 . Cultural Differences , J 8. Religious Differences L,N K,L,M,G N,G 0 K,N L,N M K,M,N N L,N K,L K L L N N K Average number of problems 4 per case 5.6 per I case To follow page 30 Table 1. Total Number and C l a s s i f i c a t i o n of Problems Referred to bv C l i e n t s T i n Intake Interviews (Comparison of Groups I-III) Problem area Group I Group II Group III Total men Women Men Women Men women A Emotional 10 23 19 12 14 17 95 C Physical health - 2 2 • - mm 3 7 D Promiscuity - 3 1 2 6 E Alcoholism - 1 1 1 3 F Socio Economic 9 7 7 6 6 5 40 Totals 19 36 30 18 20 28 151 - 31 -health, promiscuity and alcoholism. The f i v e wives saw a « t o t a l of eighteen problems and located these exclusively i n the two areas, emotional and socio-economic Three of the f i v e husbands were able to perceive t h e i r own involvement, two saw the r e s p o n s i b i l i t y as t o t a l l y t h e i r wife's. Two of the wives saw t h e i r own involvement, three believed the problems to be t o t a l l y due to t h e i r husband. In Group I I I , that i s , those cases i n which the treatment was focused dually on both husband and wife, there i s less d i s p a r i t y between the number of problems presented by the husband and by the wife. The f i v e husbands perceived twenty problems, the wives perceived twenty-eight. Again the husbands located these problems i n the emotional and socio-economic areas* the wives, i n addition, considered problems i n health, promiscuous behaviour and alcoholism, to be present. In t h i s group, two husbands and two wives were unable to admit of t h e i r own r e s p o n s i b i l i t y , i n the intake interview. In none of these cases was the factor of i n t e l l i g e n c e seen as a problem by either spouse. Considering a l l three groups together, f o r t y - s i x problems were noted i n the area of the marital r e l a t i o n s h i p . Of these, thirty-two pertained to the spouses' attitude to each other, and fourteen r e l a t e d to . the sexual performance. In t h i r t e e n incidents, concern about emotional health of s e l f or partner was verbalized. In twenty incidents, problems were seen i n the r e l a t i o n s h i p between parent and c h i l d . 32 -Since i n Groups I and I I , treatment was planned and c a r r i e d out primarily with the partner who perceived most of the problems, i t i s indicated that the partner most interested i n service i s the one who has most anxiety about the marital s i t u a t i o n . The Masculine Role In s o c i a l casework l i t e r a t u r e , as well as i n socio-l o g i c a l and p s y c h i a t r i c w r i t i n g , there i s increasing evidence of a trend toward more focus on the r o l e of the father i n the family psychological u n i t . Dr. Irene Josselyn points out that new theories of psychological development of chil d r e n have stressed the mother's importance. "The father i s too often considered of secondary importance, and he i s i n danger of becoming the 'forgotten man' . . . he i s encouraged to be the 1 c h i l d ' s playmate, not h i s parent . . . he must not be feared," Dr, Spurgeon 0 . English comments that the father, t r a d i t i o n a l l y , has been regarded as the breadwinner of the family, and, despite recent c u l t u r a l changes i n the roles of father and mother, "the facts seem to show that modern fathers do not r e a l l y understand t h e i r r o l e much better than t h e i r 2 predecessors d i d . " Dr. English points out, further, that the 1 Josselyn, Irene M., "The Family as a Psychological Unit," S o c i a l Casework. Vol. XXXIV, No. 8 , October 1953, P« 34-1. 2 English, Spurgeon 0 . , "The Psychological Role of the Father i n the Family," S o c i a l Casework. Vol. XXXV, No. 8 , October 1954, P. 323 . - 33 -father's r o l e i n the family now seems to be pointed toward a more co-operative, s o c i a l l y integrated pattern. Because of t h i s , he says, i t i s hard to formulate; "we s t i l l lack the proper terms to define our acceptance of what seems to be his 1 more passive f l e x i b l e r o l e . " Dr. English suggests the following as variants of the father's r o l e : 1. Companion and i n s p i r a t i o n for the mother; 2 . Awakener of the emotional p o t e n t i a l of hi s c h i l d ; 3 . Beloved f r i e n d and teacher to his c h i l d ; 4. Ego i d e a l f o r masculine love, ethi c s , and morality; 5. Model for s o c i a l and vocational behaviour; 6. S t a b i l i z i n g influence f o r the solution of the oedipus complex; 7. Protector, mentor, and hero f o r grade school c h i l d ; o. Counselor and f r i e n d for the adolescent. 2 Thus the i d e a l role of the father i n modern Western culture should be fa r more than that of providing the family with i t s physical n e c e s s i t i e s . When a couple i n marital c o n f l i c t seek help with t h e i r problem, the caseworker must assess the dynamics of the relat i o n s h i p between them. He i s concerned with the d i v i s i o n of roles between husband and wife, the extent to which they complement each other, and the extent to which they c o n f l i c t . When the husband f a i l s to f u l f i l l the emotional facets of his r o l e , i n regard to his wife and children, the wife's performance may be severely affected. The reverse of t h i s i s also true. The wife's normal emotional dependence on her husband i s underlined by Dr. English as 1 English, "The Psychological Role of the Father i n the Family," S o c i a l Casework, p. 204. 2 I b i d . , p. 329. - 34 -follows: Since the pattern of society i s heterosexual, a woman, i f she i s normal, can accomplish a more complete emotional f u l f i l l m e n t and wholesome personality growth through the father of her c h i l d than from any other source. A woman i s so dependent upon "psychological sets" i n her personality that even i f persons other than her husband could f u l f i l l as much as ninety per cent of her needs, she would re j e c t them as inappropriate sources. 1 A l l of the men who were seen, i n the f i f t e e n cases studied, were experiencing d i f f i c u l t i e s i n th e i r s o c i a l adjustment as functioning, adult married males. That i s , they were experiencing- d i f f i c u l t y i n the assumption of the masculine r o l e of husband and father. In some cases, i t was apparent that the wife's confusion over her feminine r o l e increased the husband's confusion over his masculine r o l e . Men who were not strongly masculine could be pushed further away from good standards of masculine performance, by aggressive, unfeminine wives. On the other hand, some of these men had so much ambivalence about the assumption of the masculine r o l e that they had poor p o t e n t i a l f o r marriage with any woman. Such a complex concept as the masculine r o l e needs explanation and exploration. For the purposes of t h i s study, a f t e r consideration of case material and source a r t i c l e s on the subject, i t was decided to indicate f i v e areas i n which the male partner i s expected to perform. These are: 1 English, "The Psychological Role of the Father i n the Family," S o c i a l Casework, p. 325. - 35 -1 . His performance as an emotional partner to h i s wife. 2 . His performance as a sexual partner to h i s wife. 3. His performance as economic provider for the family. 4 . His performance as a father to his chi l d r e n . 5. His performance as a c u l t u r a l and s o c i a l standard sette r . Ratings of "poor," " l i m i t e d , " and "good" were described i n regard to each c r i t e r i o n . The d e t a i l s are drawn together i n Schedule No. 4 , t i t l e d "Some Suggested C r i t e r i a f o r Evaluation of Performance i n the Masculine Role." In Group I, that i s , the f i v e men who could not be involved successfully i n casework treatment, the most t y p i c a l score was "poor" i n the areas of emotional and sexual partner to wife and father to the chi l d r e n . This score indicates a very low performance i n a l l relationships to the other members of the family group. In spite of t h i s i n d i c a t i o n of t h e i r inadequacy from an emotional standpoint, the score indicates limited a b i l i t y to perform as economic providers and to conform to the c u l t u r a l mores. This score i s the same as that which can be considered most t y p i c a l f or Group I I I . These were the f i v e men who participated a c t i v e l y with t h e i r wives i n casework treatment. Although t h i s group also was uniformly poor i n a l l areas of emotional relationships within the family group, the records indicate that they had ins i g h t into t h i s and were - 36 -Schedule 4. Some Suggested C r i t e r i a f o r Evaluation of Performance i n the Masculine Role C r i t e r i a Rated as: Poor ~L~imited Good 1. As emotional partner for hi s wife. Either overly-passive; over-l y domineering or shallow and s u p e r f i c i a l . Without a b i l i -ty to perceive needs of wife; demands, with-out giving; n a r c i s s i s t i c . Cannot share wife with children. Can perform well when own needs are being met, but has a low threshold of f r u s t r a t i o n . E a s i l y threatened. Has trouble sharing wife with ch i l d r e n . Not much a b i l i t y to perceive wife's needs and no a b i l i t y to put them before his own. Gives wife s e c u r i -ty and freedom from anxiety; shows an in t e r e s t i n her a c t i v i t i e s , her c r e a t i v i t y , her work, and her needs, both emo-t i o n a l and physi-c a l . Has selected a wife with good feminine i d e n t i f i -cation and accepts her more dependent r o l e . 2 . As sexual partner for wife. Potency d i s -turbances impotency, pre-mature ejecu-l a t i o n , marked perversions, promiscuity; cessation of sexual a c t i v i t y . Performs sexu-a l l y , but has anxiety around performance. L i t t l e mutual s a t i s f a c t i o n between marriage partners. No anxiety about normal sexual performance. Sexual r e l a t i o n -ship mutually g r a t i f y i n g to both partners. s economic provider for the family. Does not meet the basic eco-nomic require-ments of the family. Meets the basic economic require-ments of the family. Provides well f o r the family's economic needs beyond the sub-sistence l e v e l . 4. As"a father. Severe r e j e c -t i o n ; shallow; s u p e r f i c i a l , overly s t r i c t or unable to impose l i m i t s . Competition with children i n r e l a t i o n to wife. Some warmth and j coneern f o r c h i l -dren but cannot put t h e i r needs before his own, much of the time. Faulty understand-ing of th e i r needs because of own emotional d i f -f i c u l t i e s . In-consistent i n the quali t y and de-gree of r e l a t i o n -ship to them. Some competition with wife over children. Offers a warm consistent r e l a -tionship. Under stands t h e i r needs and s t r i v e s to meet them. Can place t h e i r needs before his own. Provides a good pattern of masculine behaviour. ^s a.'cul-t u r a l and s o c i a l standar^ultur setter. Clash with 1 s o c i a l and j a l j standards; i a n t i - s o c i a l I acting out of I u n s a t i s f i e d j needs. Conformation to s o c i a l and c u l -t u r a l standards out of fear and g u i l t . Excessive anxiety and con-cern over con-forming . L i t t l e f l e x i b i l i t y . Obtains pleasure i n meeting integrated, r e a l i s t i c s o c i a l and c u l t u r a l stand-ards. Does not have to force them r i g i d l y on others; can respect d i f f e r -ences . To follow page 3& Table 2 . Rating of the F i f t e e n Men i n Regard to Their Performance i n the Masculine Role (Based on Schedule 4 ) CASES Al IEAS Emotional Partner Sexual Partner Rel . to children Father to children Economic Provider S o c i a l Standards Group I Able poor poor good li m i t e d l i m i t e d Brown poor poor poor l i m i t e d poor Crocker l i m i t e d good poor li m i t e d poor Daniel poor poor poor li m i t e d l i m i t e d Evans li m i t e d l i m i t e d | i l i m i t e d l i m i t e d l i m i t e d Most t y p i c a l poor poor poor li m i t e d l i m i t e d Group II F e l l l i m i t e d l i m i t e d good good li m i t e d G r e n f e l l poor l i m i t e d l i m i t e d l i m i t e d l i m i t e d H a l l l i m i t e d poor good good l i m i t e d Inman li m i t e d poor poor good li m i t e d Jackson poor poor poor good li m i t e d Most t y p i c a l l i m i t e d poor variable good li m i t e d Group III King poor good li m i t e d l i m i t e d l i m i t e d Long poor poor ! poor li m i t e d l i m i t e d Manville l i m i t e d l i m i t e d poor li m i t e d l i m i t e d Nelson poor poor poor li m i t e d poor Ogden poor poor igood good good Most t y p i c a l poor i poor 1 poor •1 l i m i t e d l i m i t e d 37 -interested i n trying to change. In t h i s respect they d i f f e r e d from the men i n Group I. Again, they had at least l i m i t e d a b i l i t y to provide f o r the f i n a n c i a l needs of the family and to avoid a clash with c u l t u r a l and s o c i a l standards. Group I I , has a more variable t y p i c a l score. These f i v e men were the main focus of casework treatment. The interviews with the wives were c o l l a t e r a l . These men, as a group, showed more a b i l i t y to r e l a t e . As emotional partners to t h e i r wives they rated l i m i t e d ; sexual partner, poor; re l a t i o n s h i p to children varied from poor to good. As a group these men also performed better as economic providers, scoring "good." As i n the two other groups, they were scored " l i m i t e d " i n regard to th e i r a b i l i t y to conform to s o c i a l and c u l t u r a l standards. As a whole, these f i f t e e n cases demonstrated that these men were f a i l i n g to f u l f i l l t h e i r psychological r o l e i n the family group, although they did perform as adequate "breadwinners." Their performances from an e x t r a - f a m i l i a l view would, i n f a c t , appear f a i r l y adequate. They worked stea d i l y and conformed to most c u l t u r a l expectations of how a husband and father should behave. But i n the intimate, emotional sense, they were, i n most instances, f a i l i n g t h e i r wives and t h e i r c h i l d r e n . The d i f f i c u l t i e s presented by these areas i s commented upon by Dr. V i c t o r Eisenstein, as follows: The complexity of our society makes our marital roles much more complex than those i n any other society . . . husband must be competent not only as a breadwinner, but also as pater f a m i l i a s , even though most of his waking hours are spent f a r away from the - 38 -home on matters not even remotely connected with home and family, and even though he could not, as a c h i l d , learn his future roles by observing the a c t i v i t i e s of adult males.1 Several case i l l u s t r a t i o n s w i l l show the material on which the ratings were based. Mr, Jackson was f i f t y - t h r e e years, old and had been married for twenty-five years when he came to the Family Service Agency asking for help with his marital s i t u a t i o n . There was evident, from Mr. Jackson's description, already an emotional divorce between him and h i s wife. He described his wife as being h o s t i l e and r e s e n t f u l toward him and described himself as being fed up and exhausted by her c r i t i c i s m s and demands. He f e l t that the d i f f i c u l t y stemmed from his "nervous breakdown" which occurred a f t e r the l a s t war and said that his wife appeared angry at him for being i l l . Around t h i s time his wife became i l l h e r s e l f , with a r t h r i t i s . Mr. Jackson said "her i l l n e s s has worn me out." He f e l t that he and h i s wife had nothing i n common, and no concern f o r each other. He was considering a separation, f e e l i n g that they both would be better o f f , alone. Sexual r e l a t i o n s had ceased between Mr. and Mrs. Jackson several years before. There were four childr e n of the marriage. Three were married and l i v i n g out of the homej Mr. Jackson made no further 1 Eisenstein, Victor W., Neurotic Interaction i n Marriage. Basic Books Inc., New York, 1956, p. 56. - 39 -mention of them. He saw his wife, and youngest daughter, who l i v e d at home, as being a l l i e d against him. He said h i s wife "had taken h i s daughter away from him." She ignored h i s presence, responded to none of h i s overtures and looked to her mother f o r everything. As an economic provider Mr. Jackson was at h i s best. He had been employed as an insurance salesman f o r a number of years with the same fi r m . He derived a f e e l i n g of competence and achievement i n his work, and earned enough to provide adequately for the family. As a c u l t u r a l and s o c i a l standard s e t t e r , Mr. Jackson presented an outwardly adequate p i c t u r e . However, his conformation was l a r g e l y dictated by fear and he did so only at great cost to himself. He was very much concerned with what people thought of him and thus saw everyone as a p o t e n t i a l enemy. He was a f r a i d that he l a i d himself open to r i d i c u l e i f he deviated i n any way, from his conception of society's standards of male behaviour. Mr. Crocker shows more a b i l i t y i n the emotional areas, but less i n the other two of economic provider, and conformation to s o c i a l standards. He was forty-four years old and had been married f o r t h i r t e e n years when he and h i s wife came to the Family Service Agency. This was Mr. Crocker's second marriage. He had deserted h i s f i r s t wife and his children by her and refused to contribute anything to t h e i r support. He had l i v e d common-law - 40 -with his second wife f o r a number of months, before t h i s marriage. There were four child r e n of the second marriage, and i t was the problems of the second son that had caused Mr. and Mrs. Crocker to seek help with the marriage s i t u a t i o n . They had been advised that c o n f l i c t between them probably lay at the root of the boy's disturbed behaviour.. Although Mr. Crocker had a good income from his own business, he was u n r e a l i s t i c about contracts, commitments, and payments and the family's f i n a n c i a l s i t u a t i o n wavered between feast and famine. He was extremely dependent on h i s wife and said that "he never got upset unless she d i d . " However, he used her for a target f o r what seemed to be a considerable reservoir of h o s t i l i t y and heaped verbal abuse on her with very l i t t l e provocation. He f e l t that h i s wife was over-concerned and over-protective of the childr e n and continually expressed the f e e l i n g that he had to compete with the children f o r her attention and love. In s p i t e of t h e i r many c o n f l i c t s , both Mr. and Mrs. Crocker f e l t that t h e i r sexual adjustment was mutually s a t i s f y i n g . He paid l i t t l e attention to the ch i l d r e n , but f e l t , when they ignored him, that i t was h i s wife's f a u l t f o r "not teaching them respect." When manipulated, by the mother, int o the p o s i t i o n of sharing some a c t i v i t y with the children, p a r t i c u l a r l y the boys, he would evade the commitment, i f - 41 possible, at the l a s t minute, by being "too busy" or by "forgetting" to appear. I f the children indicated, i n any way, t h e i r disappointment and h o s t i l i t y , he responded with outraged indignation. Mr. Crocker followed no r e l i g i o u s b e l i e f s of h i s own, and, when enraged, r i d i e u l e d the r e l i g i o n of his wife and children. He was not r e l i a b l e i n h i s business dealings, drank heavily, and had been involved promiscuously with other women. Mr. Ogden was forty-two years old and had been married 10 years when he came to the agency In 1956, f o r help with the marital r e l a t i o n s h i p . He had been separated from h i s wife f o r a number of months but was considering r e c o n c i l i a t i o n " f o r the children's sake." Mr. Ogden said that h i s wife bored him and had done so, a f t e r the f i r s t month or so of the marriage. He had "known i t was a mistake from the beginning.'' He said that nothing she said or did interested him, and, on the other hand, many of the aspects of her behaviour i r r i t a t e d him beyond a l l bearing. He f e l t that he had t r i e d everything he knew to "make her over" and had f a i l e d . He f e l t that she was a dependent, rather stupid c h i l d rather than a woman. He admitted, however, that he was "too hard on other people" and was w i l l i n g to consider that he might improve the r e l a t i o n s h i p to h i s wife. Sexual re l a t i o n s h i p s i n the main had ceased. Mr. Ogden said that r e l a t i o n s with his wife were repugnant to him. 42 -He had anxiety about his male sexuality and from time to time experimented with other women. This usually terminated h i s r e l a t i o n s h i p to them. He r a t i o n a l i z e d t h i s on moral grounds. There had been i s o l a t e d incidents also, i n which Mr. and Mrs. Ogden attempted to resume sexual relationships with each other. This was a conscious e f f o r t i n which they were both uncomfortable and both had to be f o r t i f i e d with considerable alcohol before they could embark on the undertaking, which was mutually unsatisfying. Mr. Ogden continued to project r e s p o n s i b i l i t y f o r h i s sexual f a i l u r e on h i s wife, and reproached her f o r being unable to stimulate or s a t i s f y him. He warned her that he would have to f i n d himself a woman who could be a " r e a l wife" to him, since she could not. Mr. Ogden had a great deal of concern f o r h i s children. This seemed to be the only area i n which he could express warmth fo r others. While, to a c e r t a i n extent, he tended to use his c h i l d r e n as vehicles f o r h i s own ambition and pride, he kept t h i s within normal bounds. He understood the childr e n as ind i v i d u a l s and accepted t h e i r differences from each other and from him. He created opportunities to share a c t i v i t i e s with them and derived r e a l pleasure from t h e i r company. He f a i l e d them when h i s i n t e r n a l pressures were too great f o r him to tolera t e the home s i t u a t i o n , and he would absent himself from the home. He had no ins i g h t into the eff e c t on them of his periodic "holidays," which were tantamount to emotional desertion, nor the impact on them of - 43 -the poor rela t i o n s h i p between him and his wife. He f e l t that hi s wife was very l i m i t e d as a mother and saw himself as taking over both roles i n regard to the children; having to give extra because she could give so l i t t l e . In spite of these negatives, he offered them a warm, consistent r e l a t i o n s h i p , with r e a l i s t i c l i m i t s based on i n d i v i d u a l understanding. Mr. Ogden was a very successful businessman. He had inherited a fi r m from h i s father, and had taken over at the time when the business was f a i l i n g . In the span of a few years, he had made the business into a very p r o f i t a b l e one. He derived great s a t i s f a c t i o n from h i s achievement i n t h i s area. Beside the economic success, he saw his work as an outlet f o r h i s a b i l i t i e s i n organization and leadership; took pride i n the qua l i t y of hi s products, and the f a c t that he understood his men and was considered by them to be "a good man to work f o r . " I t was evident that Mr. Ogden used his work as an outlet f o r his aggressive drives, very constructively. Mr. Ogden was a " t r a d i t i o n a l i s t " and derived pleasure i n s o c i a l customs and i n s t i t u t i o n s that had been a part of h i s boyhood. These po s i t i v e pleasures he wished to preserve f o r his children. He said that he wished h i s children to be "exposed" to them and then to choose f o r themselves. His behaviour was s o c i a l l y conforming to h i s own group, and he had no anxiety about his performance. He and his wife had si m i l a r s o c i a l standards. 44 -The Learning of the Masculine Role The masculine r o l e i n Canadian culture, allows; f o r a wide var i e t y of functioning within the range of "normal" behaviour. In the main, a man learns h i s masculine r o l e from his father. The extent to which he has i d e n t i f i e d with h i s father, and the patterns of behaviour that father has set f o r him, may l a r g e l y determine his patterns of adult functioning. In some cases where problems appear, i d e n t i f i c a t i o n i s weak. In others, i d e n t i f i c a t i o n had been achieved, but to a pattern of masculine behaviour that was weak or pathological. In the males observed i n t h i s study, most cases revealed pathology i n t h i s area of i d e n t i f i c a t i o n with the father. Several examples have been chosen to i l l u s t r a t e this.background material, which seems relevant to the e x i s t i n g marital d i f f i c u l t i e s . Mr. Brown was one of that group of men who\ could not e f f e c t i v e l y be involved i n casework treatment. He was f i f t y - o n e years old when the case was opened by the Family Service Agency i n 1956. The wife came f i r s t to the agency because, she said, she could no longer t o l e r a t e what the marital r e l a t i o n s h i p was doing to the c h i l d r e n . She described problems around husband's behaviour that indicated mental i l l n e s s i n the husband and said that he had behaved l i k e t h i s since the beginning of the marriage. The Brown's had been married f o r twelve years and had l i v e d common-law for eight years p r i o r to t h i s . The union had been p r e c i p i t a t e d by Mrs. Brown's i l l e g i t i m a t e pregnancy. - 45 -Mr. Brown, who c l e a r l y could not be treated by casework methods because of his deep-rooted problems (he was l a t e r diagnosed as paranoidal and committed f o r p s y c h i a t r i c treatment), had experienced very damaging relationships i n his early years with h i s father and mother. His father was P o l i s h and h i s mother I t a l i a n . They fought b i t t e r l y and constantly. His father was an a l c o h o l i c and behaved b r u t a l l y with the wife and the ch i l d r e n , p a r t i c u l a r l y Mr. Brown who was the only son. There were several g i r l s . The mother was over-protective and permissive with Mr. Brown. In marriage Mr. Brown had chosen a woman who would submit masochistically to him a f t e r the fashion of his own mother, and allow him to act out the r o l e played by h i s father. The phenomena of " i d e n t i f i c a t i o n with the aggressor" i s apparent here. However, when hi s wife, strengthened by the supportive r e l a t i o n s h i p with the caseworker, moved against him and put l i m i t s on h i s behaviour, he said "I always knew you would do t h i s some day." I t was apparent, from the f a c i l i t y with which he reversed h i s rela t i o n s h i p to her, that he was ready to play the r o l e of the vietim* that i s the role played by h i s mother. He was, i n f a c t , confused and ambivalent about h i s i d e n t i f a c t i o n s with mother and father. Mr. Evans' pattern of behaviour also indicated the e f f e c t of traumatie early experiences i n r e l a t i o n to h i s father. His parents were Ukraniah and Mr. Evans was one of a family of ten c h i l d r e n . He says that h i s father was - 46 -alc o h o l i c and exploited the whole family. He was p h y s i c a l l y abusive to the mother and to the children. Mother was a hard-working, submissive woman who t r i e d to keep the family together, but was unable to protect h e r s e l f or the children from father's rages. She attempted to persuade the chi l d r e n to submit to father passively i n order to buy peace at any p r i c e . Mr. Evans says he learned early to stay out of father's way, af t e r he had been beaten a few times. He t r i e d to help mother i n any way that he could. He witnessed how-ever, many scenes between his father and the other sons, who were not as ready to submit. When Mr. Evans was f i f t e e n years old, he witnessed a scene between the oldest son and the father i n which the oldest son knocked the father into a metal bedpost, putting out hi s eye. Mr. Evans describes the scene v i v i d l y , with s t i l l - a p p a r e n t horror. Immediately a f t e r t h i s he l e f t home. He changed h i s name to avoid any associa-t i o n with the father, who, he sai d , had caused him to be rejected by everyone i n the community. Although he f e e l s that he has "made good," he also f e e l s that everyone would re j e c t him " i f they knew" (of h i s background) and constantly f e e l s that he must maintain a facade. He f e e l s s o c i a l l y i n f e r i o r to hi s wife, who i s an aggressive woman, and constantly c r i t i c i z e s her performance as homemaker and mother, i n comparison to hi s own mother. He tends to t r y and take over from her i n regard to running the home and i n regard to the children. He seems to f e e l that he could 47 -f u l f i l l the mother role better than she can. He feels constantly abused and misunderstood by. his wife, whom he sees as harsh and rejecting of him, and has a great deal of anxiety about what he feels is her sexual rejection. He says that after what he had to live through in his boyhood, he should not have to live through again with his wife, but here i t was happening again. He cried easily when describing his situation, but felt ineffectual about changing i t , saying that there was nothing he could do; i t was up to his wife. Mr. Evans seems to have attempted to assume, in many ways the patterns of his mother, rather than his father, and has recreated in his marriage a situation in which he again feels exploited. These two cases demonstrate the traumatic effect on a male child who is raised in a family group where the father is aggressive and the mother is passively enduring. Difficulty in masculine identification can ensue, also, however, when the reverse is the case. A recent study conducted at the Menninger Clinic illustrates the problem presented to a boy in resolving the oedipal conflict and achieving masculine identification when the father is passive and the mother is aggressive. The following comment is made: A passive father and an aggressive mother create the setting in which the child's unconscious methods of resolving his instinctual needs bring him to neurotic grief. It is not surprising that there appears to be a correlation between extreme passivity of the father - 48 -and the degree of cas t r a t i o n anxiety, femininity and p a s s i v i t y i n the boy.l The following two cases i l l u s t r a t e such family s i t u a t i o n s . Mr. F e l l ' s r e l a t i o n s h i p s with h i s father and mother indicated considerable pathology. He describes a marital balance between hi s parents i n which the mother assumed the aggressive, masculine r o l e . She wore men's clothes and spent most of her time out with the men working about the farm. The father was an unhappy, moody person who frequently threatened s u i c i d e . He had ca r r i e d out t h i s threat, success-f u l l y , about f i v e years before, and Mr. F e l l expressed h i s fe e l i n g that t h i s had been due to the way that his mother had treated his father. Mr. F e l l speaks warmly of his father and says he i s very l i k e him i n many ways, he shares the same interests and gave as an example the f a c t that they both l i k e d to cook, which was one job mother d i d not l i k e to do, and l e f t to father. His desc r i p t i o n of his mother's behaviour Indicates strong obsessive compulsive elements. He spent most of his time with father and used to l i k e to help him. There was a f l a s h of h o s t i l i t y when he said that he used to resent the f a c t that father would never l e t him s t a r t a job on h i s own. He also said that a c t u a l l y he f e l t father had done more f o r s i s t e r than he had for him. But, i n the main, any h o s t i l i t y that Mr. F e l l has f o r h i s father i s well 1 Rubenstein, Ben. 0., and L e v i t t , Morton, "Some Observations Regarding the Role of Fathers i n Child Psychotherapy," B u l l e t i n of the Menninger C l i n i c . V o l . 21, No. 1, January 1957, P. 24. - 49 -suppressed, and h i s i d e n t i f i c a t i o n with father seems pretty d e f i n i t e . Mr. King was the youngest of eleven c h i l d r e n i n a family of German r a c i a l o r i g i n . When he was born, his father was sixty-three years of age and the mother was forty-two years of age. He f e l t that his mother was the strong one of the two and much of the r e s p o n s i b i l i t y f e l l to her i n maintain-ing the family. He said that he thought i t had been d i f f e r e n t when h i s father was successful f i n a n c i a l l y , but a f t e r he l o s t his money and business during the i n f l a t i o n i n Germany, a f t e r the f i r s t World War, he had deteriorated. He.says that h i s parents could not get along and he r e c a l l s q u a r r e l l i n g , f i g h t i n g and many threats of divorce. His mother t o l d him that i t had been d i f f e r e n t before they had been married, when they l i v e d together happily. (His parents had l i v e d together i n common-law union and had four chi l d r e n p r i o r to the marriage, Mr. King's father had been married previously.) The mother seems to have been very possessive of t h i s youngest c h i l d . Mr. King describes h i s father as a very quiet man, who withdrew into his world of obscure inventions. He says that he never saw his father happy or unhappy. He f e e l s that he looks l i k e father and i s l i k e father. - 50 -M a r i t a l Interrelationships and the Problem of Excessive Dependency In addition to the assessment of the male's performance i n h i s r o l e , the caseworker must consider care-f u l l y the basis of r e l a t i o n s h i p between him and h i s wife, determine what the balance has been In the past, and the best equilibrium which can be attained between these two people, considering t h e i r i n d i v i d u a l strengths and weaknesses. Thus, while the caseworker seeks to understand the extent of i n d i v i d u a l pathology i n the treatment of marital c o n f l i c t cases, the i n d i v i d u a l adjustment must be v i s u a l i z e d within the context of the marital r e l a t i o n s h i p , and t r e a t -ment goals appropriately geared to t h i s conception. Ackerman points out: A r e l a t i o n s h i p represents more than the sum of the pe r s o n a l i t i e s that make i t up. A marital r e l a t i o n -ship, l i k e a chemical compound, has unique properties of i t s own over and above the c h a r a c t e r i s t i c s of the elements that merge to form the compound. A new l e v e l of organization creates new q u a l i t i e s . A marriage rel a t i o n s h i p i s therefore an e n t i t y new and d i f f e r e n t , but again l i k e a chemical compound, i t s properties while unique, preserve a s p e c i f i c dynamic r e l a t i o n to the elements that have joined i n i t s creation.1 Florence H o l l i s points out that: A mature marriage adjustment requires that he must have freed himself of strong c h i l d i s h parental attachments, that h i s s p e c i f i c sexual drives be directed toward the opposite sex, and that he be able t r u l y to perceive and care about the feelings and needs of h i s partner. 2 1 Ackerman, oj>. c i t . . p. 140. 2 H o l l i s , Florence, Women i n M a r i t a l C o n f l i c t . Family Service Association of America, New York, 1949. - 51 -Many people who marry do not meet these require-ments, and th e i r marriage cannot be said to be "mature.** Many attempts have been made to define a mature marriage r e l a t i o n s h i p . Ackerman's i s perhaps the most comprehensive: Presumably such a re l a t i o n s h i p would be characterized by a r e l a t i v e l y clear awareness of goals, p o s i t i v e i n emphasis rather than defensive; these goals reasonably shared by both partners would be r e l a t i v e l y r e a l i s t i c , stable and f l e x i b l e . There would be a modicum of compatibility i n the main s o c i a l , sexual, economic and parental areas. C o n f l i e t would not be excessive, would be under c o n t r o l , and would have mainly a r e a l i s t i c , rather than an i r r a t i o n a l content. There would be empathic tolerance of differences based on mutual understanding and equality; also tolerance of any re s i d u a l immaturities of need which may be present i n either partner. There would be reasonable sharing of pleasure, r e s p o n s i b i l i t y and authority. There would be reasonable f u l f i l l m e n t of goals both for the rel a t i o n s h i p and fo r the further development of each partner as an i n d i v i d u a l . Each would be as much concerned f o r the welfare and development of the partner as f o r the s e l f . Where differences e x i s t , the mutual, unreserved acceptance of each partner by the other would make of these differences a stimulus for growth, both for the re l a t i o n s h i p and for each partner as an i n d i v i d u a l , rather than a basis f o r c o n f l i c t or i s o l a t i o n . A c t u a l l y performance i n marriage would reasonably approximate goals. There would be a r e l a t i v e l y high complementarity on a p o s i t i v e basis as husband and wife and as father and mother. There would be no s i g n i f i c a n t trend toward i s o l a t i o n , d i s i n t e g r a t i o n or regression.1 Obviously such an i d e a l i z e d concept of the marriage relat i o n s h i p i s ra r e l y encountered, and c e r t a i n l y does not exist between husbands and wives who must seek outside help to resolve t h e i r d i f f i c u l t i e s . A l l too often, people seek to c o l l e c t old debts from the marriage partner by seeking to g r a t i f y r e s i d u a l c h i l d i s h needs unmet by the parents. The 1 Ackerman, o j a . cit.« p. 147. - 52 -marriage relationship can become the vehicle for old hosti l i t ies , old dependencies, and old ambitions. Among a l l the cases studied, disturbed patterns of interrelationships between the partners were discernible. These patterns, based, in part, on those defined by 1 Mittlmann, are as follows: (1) and (2) One partner aggressive, dominant: the other chiefly dependent, submissive and enduring. The aggressive partner is out to humiliate and hurt his partner, thus relieving his own anxiety aroused by the relationship. The dependent role may be played by either husband or wife. Both roles are charged with conflicting trends, leading to outward disturbances. (3) One withdrawn mate, one demanding mate. An attempt at feeling self-sufficient through emotional detachment on the part of one partner, with an intense open demand for love on the part of the other. When the demands of the dependent mate arouse the other's fears, he becomes even more detached. This represents rejection to the dependent mate. Both partners blame each other for their diff iculties. (4) Both mates struggling for control. Mutual attempt at domination, coupled with violent defense. Both partners are cr i t i ca l of each other, feel constantly 1 Mittlmann, Bela, M.D., "Analysis of Reciprocal Neurotic Patterns in Family Relationships," Neurotic Interaction in Marriage. edited by Victor W. Eisenstein, M.D., Basic Books, New York, 1956. insulted and humiliated and set out to humiliate each other i n turn. They are both i n need of a f f e c t i o n . Their intense longing for dependence i s either unconscious, r e s u l t i n g only i n greater sensitiveness, or i t i s not recognized i n i t s f u l l i n t e n s i t y and i s presented as a genuine desire f o r a f f e c t i o n . Each wants to win a complete v i c t o r y over the other at any cost, and because of strong dependency needs each i s alarmed at the prospect of losing the other. (5) Both mates excessively dependent. Mutual attempt to assume the dependent r o l e , and to be cared for by the other partner, with no demands on s e l f . Demands made on the partner are u n r e a l i s t i c ; there i s ensuing h o s t i l i t y when dependency needs are not g r a t i f i e d by partner. While a l l of these patterns were d i s c e r n i b l e i n the cases under study, and each f e l l f a r short of the concept of a mature marriage r e l a t i o n s h i p between the partners, as described by Ackerman; i t was also clear that t h i s d i s t o r t i o n of the marriage r e l a t i o n s h i p had provided hope of g r a t i f i c a t i o n for both partners, to a c e r t a i n extent. Mittlmann points out that i n a l l patterns, s a t i s f a c t i o n s may come by both mates fi n d i n g security, s a t i s f a c t i o n and increased self-esteem through a mutually o v e r - i d e a l i s t i c approach to l i f e ; and, being h e l p l e s s l y dependent, each considers the other a haven of refuge, and by 1 helping the other, helps himself. 1 Mittlmann, Neurotic Interaction i n Marriage, p. 85. - 54 -Schedule 5- Patterns of M a r i t a l Interrelationships Pattern | Group I Group I I Group I I I i 1. Submissive husband* dominant wife A,E 0,1 L 2 . Submissive wife* dominant husband. B 3- One withdrawn mate, one demanding mate. o 4 ' Both mates struggling for control. H K 5 . Both mates excessively dependent. C,D 1 M,N 1 - 55 -I t can r e a d i l y be seen that the husband's excessive dependency i s a factor i n the disturbed i n t e r r e l a t i o n s h i p s between husband and wife, i n the majority of the cases. This i s true i n eleven cases out of the t o t a l of f i f t e e n . Four of these occur i n Group I, four occur i n Group II and three i n Group I I I . There would not, therefore, appear to be any basis for the hypothesis that treatment focus i n regard to the males i s contingent on the r o l e that he assumes i n regard to his wife. Common to a l l of these f i v e patterns, i s the inappropriate use of defense methods against anxiety. They may be termed inappropriate because of the r i g i d i t y of the defense system. Saperstein points out that the mature person i s able to use, with equal f a c i l i t y , and appropriately, three patterns of defense mechanisms, namely: fear and with-drawal, s e l f assertion or h o s t i l i t y , and dependency. He comments, " I f the organism constantly misuses i t s defenses, i t remains i n an almost continuous state of maladaptlon and 1 thereby perpetuates the anxiety state, i f i t survives at a l l . " A person thus l i m i t e d i n h i s adaptive powers w i l l obviously experience d i f f i c u l t i e s , not only i n the intimate rel a t i o n s h i p of marriage, but In a l l h i s other r e l a t i o n s h i p s . I f the caseworker can help him to see h i s present s i t u a t i o n i n perspective, the c l i e n t may be on the way to the solution of his d i f f i c u l t i e s . "Thus the diagnosis s h i f t s from the marriage 1 Saperstein, Milton A , Emotional Security. Crown Publishers, New York, 1948, p. 25. to the i n d i v i d u a l . The problems i n the marriage cease to exist as a disease e n t i t y . Instead, i n the eyes of the-case-worker and c l i e n t , these problems become another manifestation 1 of the c l i e n t ' s t o t a l approach to human relationships.™ Examples chosen at random: The Able case i l l u s t r a t e s the pattern of the sub-missive husband and dominant wife. Mr. and Mrs. Able had been married f o r four years and had one son, two and a h a l f years o l d , when they came to the agency f o r help with t h e i r marriage. Mr. Able could not e f f e c t i v e l y be involved i n casework treatment and was seen by the caseworker only once. A l l of the problems, as he saw them, came out of his wife's performance i n her r o l e , and he was unable to accept any of the r e s p o n s i b i l i t y himself. He appeared to be i n r e v o l t against his dependent r o l e , and was trying to reverse his po s i t i o n and control h i s wife. He was doing t h i s through threats of desertion and h i s involvement with another woman which was undermining h i s wife's already weak i d e n t i -f i c a t i o n as a woman. Mrs. Able was very h o s t i l e to men and deprecated her husband, saying he "had never stood up to her before" and he "had been such a pansy i n her eyes." Mr. Able f e l t that he had never gained any s a t i s f a c t i o n s i n the marriage. He said of h i s wife "She takes a l l of the weight on her own shoulders and makes me f e e l less of a man." Their "marriage had been 75% for her and 2% f o r him." Gf 1 Flesch, l o c . c i t . - 57 -himself Mr. Able said "He was lonely and she had never needed anyone because she was so strong," and "He didn't go int o marriage to be a housewife." In spite of Mr. Abie's protestations that he was through with the marriage and had only come i n to see the caseworker to convince h i s wife, or to have her convinced, that she should give him a divorce, at the close of the case Mr. and Mrs. Able were s t i l l l i v i n g together. Mrs. Able was again pregnant. Mr. Able was drinking quite heavily, and had forced more compliance on h i s wife's part, so h i s g r a t i f i c a -tions had increased. This sort of r e l a t i o n s h i p , i n which the submissive male cloaks h i s g r a t i f i c a t i o n of h i s dependency needs by protest, i s not an unusual one. Florence H o l l i s points out: . . . the neurotic may, l i k e the i n f a n t i l e person, s t i l l be seeking to g r a t i f y h i s love needs through a dependent close association with his mother or a mother substitute, but his ego f o r one reason or another perceives t h i s as dangerous and/or inappropriate and t r i e s to prevent i t . I t i s not however, strong enough completely to carry out t h i s p r o h i b i t i o n and release the energy f o r more appropriate g r a t i f i c a t i o n . Instead the i n d i v i d u a l hides h i s wish from himself but so arranges h i s l i f e that h i s wish i s p a r t i a l l y c a r r i e d out, as i t were, of necessity and against his w i l l . Such an arrangement always includes circumstances that cause him suffering which counterbalances h i s secret pleasure.1 The pattern of the dominant husband, submissive wife amongst the f i f t e e n cases studied was the Brown case. This case was an exceptional one, i n that the husband was 1 H o l l i s , op_. c i t . , p. 1 6 . suspected and l a t e r diagnosed as a psychotic, suffering from paranoia. The Brown's had been l i v i n g together f o r twenty years when the case was opened i n 1 9 5 6 . They had l i v e d i n a common law union f o r the f i r s t eight pf these twenty years. The common-law union had been p r e c i p i t a t e d by Mrs. Brown's i l l e g i t i m a t e pregnancy. Mrs. Brown came to the agency, she said for help with the s i t u a t i o n , as she could no longer toler a t e what t h i s was doing to the children. She described these twenty years as b r u t a l domination on the part of the husband but said that " l e f t to h e r s e l f she would never dream of separating from her husband." Mr. Brown came twice to see the caseworker. He saw the problems as being h i s wife's attitude towards him, her sexual r e j e c t i o n of him, and h i s wife's management of the money. The wife saw the problems as being, her husband's attitude toward her and the c h i l d r e n , h i s suspected i l l health p h y s i c a l l y and mentally, h i s d i f f e r e n t temperament because of h i s d i f f e r e n t culture, h i s promiscuity, and her own "nervous troubles." Mr. Brown viewed every one with suspicion and i n s i s t e d on dominating everyone she s a i d . She described him as being harsh, tyrannical and demanding. Mr. Brown said that i t was not possible f o r him to change himself and i t was necessary f o r the caseworker "to change" h i s wife so that she would better meet hi s needs. He "had to have" the respect of h i s family and i f he did not have t h i s , he had nothing. He saw h i s headaches and h i s stomach upsets as being d i r e c t l y r e l a t e d to any attempt h i s family made to - 59 -deny him this dominant role. Of such behaviour, Saperstein says: The outstanding example of attempted self-sufficiency is seen in the paranoid syndrome. In this state, the individual denies any need for other human beings, sees them only as enemies who are challenging his own underlying grandiosity. He blames others for his d i f f i c u l t i e s , and becomes easily enraged and vindictive when he feels his supremacy challenged. He i s frequently the 'savior' of the world, or he may take on other grandiose characterizations. This i s the height of delusional self-sufficiency and denial of dependency.l The pattern of one withdrawn mate, one demanding mate is illustrated by the Ogden case. Mr. Ogden plainly used the defense method of withdrawal, to handle the anxiety engendered by the marital relationship. Although he had strong dependency needs and could verbalize these, he was not able to express these to his wife. When drunk he would say that "he had to find a woman to look after him," as his wife could not. He told the caseworker that he had "been way out on a limb" when his mother died, and would never place himself in the same position again. It would appear that Mr. Ogden wished to gratify his strong continuing dependency needs with a mother substitute, but since he was unable to allow himself this gratification which engendered so much anxiety, he with-drew emotionally from his wife. The unconscious incestual quality of sexual relationships with the mother substitute also resulted in intense anxiety and Mr. Ogden found such relationships repugnant to him. The wife was extremely 1 Saperstein, op,, c i t . - 60 -dependent, and became panic-stricken i n the face of her husband's emotional desertion, expressing t h i s i n depression. The Ogdens had been married f o r ten years when the case was opened by the Family Service Agency. They were separated at that time, and were contemplating a r e c o n c i l i a t i o n . There had been several such separations and r e c o n c i l i a t i o n s i n the past. Mrs. Ogden had been passive about these decisions. Mr. Ogden seems to have followed a pattern of withdrawing completely when the pressures grew too great for him and h i s returns seem dictated by insight into h i s desire not to "end up alone." Both Mr. and Mrs. Ogden were able to see something of t h e i r own involvement i n the problem, although both were c r i t i c a l of the way the other f a i l e d to meet t h e i r emotional needs. The King case i l l u s t r a t e s the s i t u a t i o n where both partners are struggling f o r c o n t r o l . Mr. and Mrs. King had been married f o r four years when they came to the Family Service Agency f o r help. They had one c h i l d , a g i r l , age three years. They had been talking about separating but f e l t that they wanted marriage counselling before making such a decision. Mrs. King said the problem was primarily the f a c t that Mr. King wanted to rule her. She was not w i l l i n g to accept such domination. Mr. King f e l t that his wife, i n turn, was trying to rule him by forcing her own s t r i c t s o c i a l standards, upon him. He admitted that he was •jealous of his - 6 l -wife, that he had a strong temper and that he could not always control h i s behaviour. He f e l t that a contributing factor to his unhappiness was his lack of pleasure or achieve-ment i n h i s work. It seemed obvious that Mr. King had a considerable struggle to repress his desire for dependency on a mother substitute, and Mrs. King's e f f o r t s to control him increased his anxiety. There was considerable confusion i n t h i s case, around Mr. and Mrs. King's conception of the respective roles of husband and wife. Mr. King who was very dependent on his mother, saw her as c o n t r o l l i n g his father and seemed to both fear and desire the same thing happening to him. Mrs. King on the other hand, had grown up i n a family where the father was quite comfortable i n assuming a dependent p o s i t i o n with the mother, and saw th i s as an acceptable pattern. Mr. King was evidently defending himself from cas t r a t i o n anxiety, by the pattern of s e l f assertion or h o s t i l i t y , and Mrs. King was using the same weapons to maintain what she f e l t should be her p o s i t i o n . Miss Flesch points out the damaging effects of such a struggle around dependence. Husbands need to f e e l that t h e i r wives can depend upon them. The husband's inner anxieties, when exacerbated by the wife's struggle against her feminine dependence, may undermine his confidence i n his own adequacy. He may over-react against even normal dependence upon h i s wife and propel himself into continual over-work. As a r e s u l t he becomes r e s e n t f u l of his. wife's dependence. The couple's struggle robs them of emotional and sexual f u l f i l l m e n t i n the marriage.1 1 Flesch, op_. c i t . . p. 358. - 62 -There were s i x cases on which the pattern was that of both mates being excessively dependent. The Jackson case provides a good i l l u s t r a t i o n . Mr. and Mrs\ Jackson had been married f o r over twenty years, when Mr. Jackson came to the agency asking for help with the s i t u a t i o n . He was wondering about whether he should separate from his wife. He saw the problems as her h o s t i l e attitude to him, and her success i n alienating the six year old daughter from him. There were four other grown up childr e n who had married and l e f t the home. He said that there had been no sexual intercourse between him and h i s wife f o r several years. He suspected that :his wife was mentally i l l because of the way she acted toward him, and said that "her a r t h r i t i s had worn him out." Because of the unhappy s i t u a t i o n at home, he f e l t that his health was s u f f e r i n g . The wife, who was not receptive to casework service, at f i r s t took the stand that there were no problems, but f i n a l l y verbalized her h o s t i l i t y towards her husband, saying that she f e l t the problems were his attitude to her and to the children, and h i s management of the money. The history of the marriage revealed that a great deal of d i f f i c u l t y was generated at the time of Mr. Jackson's "nervous breakdown," which occurred a f t e r the l a s t war. He described i t as a complete collapse, and said that the main symptom was loss of memory. He was i n s t i t u t i o n a l i z e d for several months. He noted that h i s wife "had appeared angry with him for being i l l . " A f t e r Mr. Jackson had made his recovery, Mrs. Jackson - 63 -had become i l l with a r t h r i t i s . There was no background information i n regard to Mr. Jackson, but his way of r e l a t i n g to the caseworker gave every i n d i c a t i o n of strong dependency needs and his desire to lean on a mother substitute. Mrs. Jackson's background showed considerable emotional deprivation. She was, i n addition, the only g i r l i n a family of f i v e boys, and had always resented the f a c t that she had had to work so hard, i n comparison to her brothers. There was a great deal of h o s t i l i t y between the partners because of the i n a b i l i t y of each to meet the exorbitant dependency needs of the other. S t i l l , the f a c t that the marriage had survived f o r such a long period, and gave every i n d i c a t i o n that i t would continue, i n spite of Mr. Jackson's verbalized desire to separate, indicated that each i n t h e i r helplessness considered the other a haven of refuge. In a l l of these patterns of disturbed i n t e r r e l a t i o n -ship i n marriage, i t i s possible to say that the problem of dependency had never been adequately handled by the partners, either f i r s t , as i n d i v i d u a l s , or together, as husband and wife. While patterns such as the Able and Jackson cases show an overt expression of excessive dependency on the part of the husband; patterns such as the Brown, Ogden and King cases show what might be termed "the other side of the same coin." Saperstein comments: "Dependency becomes a self-defeating defense when used too much—that i s , when an adequate organism - 64 -t u r n s f o r h e l p r a t h e r t h a n use i t s own ample c a p a c i t y — o r t o o l i t t l e , when t h e o r g a n i s m i s o l a t e s i t s e l f u n n e c e s s a r i l y f rom •' 1 t h e s u p p o r t of o t h e r members of i t s s p e c i e s . " I t i s n o t s u r p r i s i n g t h a t a l l of t h e s e f i f t e e n men showed e i t h e r marked dependence o r an o v e r - r e a c t i o n a g a i n s t dependence, i n t h e m a r r i a g e r e l a t i o n s h i p . The s t r o n g pos-s i b i l i t y o f an immature m a r r i a g e r e l a t i o n s h i p was i n d i c a t e d by the f a c t t h a t t h e i r performances i n t h e m a s c u l i n e r o l e was l i m i t e d i n so many a r e a s . S u p p o s e d l y , s u c h a man, who i s h a v i n g d i f f i c u l t y i n h i s a d u l t a d j u stment t o t h e s t a n d a r d s o f male performance imposed by t h e c u l t u r e , c o u l d n o t be c o n s i d e r e d mature. An immature p e r s o n does n o t have t h e a b i l i t y t o make a mature c h o i c e i n m a r r i a g e , o r t o r e l a t e on a mature l e v e l i n t h i s i n t i m a t e s i t u a t i o n . M i s s H o l l i s p o i n t s o u t : The p e r s o n who i s dependent i n h i s l o v e r e l a t i o n s h i p s o f t e n shows o t h e r s o r t s o f dependence. Such p e o p l e a r e no t s e l f - r e l i a n t . They f i n d i t h a r d t o make major d e c i s i o n s and p r e f e r t o be t o l d what t o do. O f t e n t h e y c o n t i n u e t o r e l y on p a r e n t a l s t a n d a r d s o f conduct and seek a d v i c e i n a way t h a t i s d i s t a s t e f u l t o the average a d u l t . 2 I n most c a s e s , t h e husbands were w e l l aware of t h e f a c t t h a t i t was t h e q u a l i t y o f t h e i r r e l a t i o n s h i p t o t h e i r w i f e t h a t was c a u s i n g t h e i r d i s c o m f o r t , as t h i s o c c u r r e d w i t h g r e a t f r e q u e n c y i n t h e "Problems" s c h e d u l e . I t seems t h a t 1 S a p e r s t e i n , pj3. c i t . . pp. 26 -27 . 2 H o l l i s , .op., c i t . , p. 23 . - 65 -t h i s aspect of t h e i r functioning was, by f a r , the most d i f f i c u l t f o r them. While i t i s possible f o r a mature man to make a mistake i n his s e l e c t i o n of a mate, the l i k e l i h o o d i s , that he would quickly discover and correct t h i s f a c t , by solving the d i f f i c u l t y with h i s wife, or ex t r i c a t i n g himself from the marriage. Contrary to t h i s most of the men i n t h i s study gave every i n d i c a t i o n , not only of enduring, but clin g i n g to the marriage, which purportedly gave them l i t t l e s a t i s f a c t i o n . Eidelberg discusses t h i s phenomenum: To most analysts the concept 'neurotic choice of mate' connotes a marital s e l e c t i o n which i n i t s e l f i n t e r f e r e s with normal relationships or makes them so d i f f i c u l t that the displeasure exceeds the pleasure derived there-from. A neurotic choice of mate may be the r e s u l t of various unconscious defense mechanisms. F i x a t i o n or regression to one of the three stages of development generally l i e s at the core of the problem . . . . A l l three types of defense mechanisms can i n t e r f e r e with the choice of mate by making the person select someone who helps p a r t l y to g r a t i f y and partly to deny the presence of i n f a n t i l e wishes. In other words, whenever a neurotic choice i s made the patient instead of choosing a person with whom he could be happy, has selected an object he needs i n order to avoid recognizing what he i s a f r a i d o f . l Since the r e l a t i o n s h i p , immature and even neurotic, as i t i s , does o f f e r protection, i f nothing e l s e , why do such couples often come to a s o c i a l agency, supposedly on the verge of separation? The answer seems to l i e i n the f a c t that such a marital balance i s precarious, and external forces can ea s i l y disrupt the balance so that the same degree of 1 Eidelberg, Ludwig M.D., "Neurotic Choice of Mate," Neurotic Interaction i n Marriage. edited by Vic t o r W. Eisen s t e i n M.D., Basic Books Inc., New York, 1 9 5 ° , PP. 57,58 - 66 -protection and g r a t i f i c a t i o n i s no longer forthcoming. In some cases, the goal i s to help the couples restore the old balance* i n others, i t i s to help them create a new one. In addition, Saperstein points outs Our most neurotic i n d i v i d u a l s are constantly searching for perfect relationships which they f e e l w i l l solve a l l of the i r personal problems. They never succeed because no human relationships remain f i x e d , without a wall of a r t i f i c i a l i t y to sustain i t . Since the needs of people are i n a state of constant f l u x , healthy interpersonal relationships are characterized by constant modification to meet whatever needs present themselves.1 The goal of the caseworker i n marital counselling i s often that of helping the individ u a l s concerned to be more r e a l i s t i c about t h e i r expectations of what the marital re l a t i o n s h i p can give them, and to develop together t h i s f l e x i b i l i t y to deal with new problems. In t h i s study, eleven of the f i f t e e n husbands, or 73 per cent showed excessive dependence on t h e i r wives. This i s a somewhat higher per cent of excessive dependence than H o l l i s found i n her study of women i n marital c o n f l i c t . She noted that i n twenty cases out of the t h i r t y - s i x studied, the women were excessively dependent. She adds, "Had we been able to study the husbands as well as the wives i n our 100 couples, we suspect that we would have found t h i s self-same pattern, and not infrequently found that both partners were dependent children each seeking an elusive security i n the 1 Saperstein, op_. c i t . . p. 92 . - 67 -1 other." In none of these f i f t e e n cases, did the economic factor occur alone, and on examination, economic d i f f i c u l t i e s present seemed to r e f l e c t the emotional weaknesses i n e i t h e r , or both, partners and the r e l a t i o n s h i p between them. While i t i s true that f i n a n c i a l d i f f i c u l t i e s exacerbated emotional d i f f i c u l t i e s i n several of the cases, treatment could not e f f e c t i v e l y be directed towards the f i n a n c i a l problem per se. In regard to the factor of c u l t u r a l differences, i t i s i n t e r e s t i n g to note that i t occurred i n one case only, and on closer examination proved to be unfounded i n f a c t . In t h i s case, the wife saw part of the problem as being her husband's "Spanish" temperament. As the case developed, i t became apparent that t h i s had been only part of the fantasy he had woven around himself, at the dictates of his mental i l l n e s s . H o l l i s points out that, i n the main, people do not marry beyond t h e i r own boundaries of c u l t u r a l tolerance, unless b a s i c a l l y they need to enter into a neurotic marital r e l a t i o n -ship . D i f f i c u l t i e s i n the r e l a t i o n s h i p between parent and c h i l d were frequently mentioned. Again these were not treated d i r e c t l y as they seemed to be a r e f l e c t i o n of the c o n f l i c t between the partners. However, these problems were sometimes the p r e c i p i t a t i n g factor i n bringing the couple to the agency, seeking to change t h e i r marital adjustment. 1 H o l l i s , op., c i t . . p. 206. CHAPTER 3 ASSESSMENT OF TREATABILITY AND TREATMENT METHODS USED The concept that treatment and diagnosis are simultaneous processes i s constantly put forward by authori-t a t i v e s o c i a l work wri t e r s . There i s no one point at which i t can be said that the caseworker, having established a diagnosis, sets the treatment goals, selects the appropriate techniques and embarks, with the c l i e n t , on the treatment program, Basic to a l l treatment techniques i s the r e l a t i o n -ship between the c l i e n t and worker, and t h i s begins at the moment the c l i e n t enters the caseworker's o f f i c e f o r the f i r s t time. I t i s true however, that a f t e r a period of several interviews, the caseworker should have material from which she can formulate a tentative statement of the d i f f i c u l t i e s f or the c l i e n t , inherent i n the s i t u a t i o n he i s experiencing, and plan the d i r e c t i o n and method of treatment. In a r r i v i n g at t h i s stage, the caseworker must form an assessment of the c l i e n t ' s p o t e n t i a l a b i l i t i e s to solve the problem s i t u a t i o n ; or his " t r e a t a b i l i t y . " T r e a t a b i l i t y depends on two fa c t o r s ; the c l i e n t ' s a b i l i t y to use services; that i s , h i s emotional health or ego strength, and h i s willingness to use services. These two factors are not necessarily present to the same degree. A - 6 9 -c l i e n t with good a b i l i t y to use the service, i n terras of h i s ego strength, may not wish to do so. He may f e e l that the service i s not approporate f o r him; that the caseworker i s already prejudiced i n h i s wife's favour; or that the case-worker may pressure him to remain i n a marriage that he no longer wants, or the reverse. Also, although he can perceive the problems i n the s i t u a t i o n , he may not be s u f f i c i e n t l y motivated towards change, but may prefer to handle h i s d i s -comfort i n other ways. What i s Ego Strength? In casework treatment, given the c l i e n t ' s desire to change h i s adjustment to an external s i t u a t i o n , the degree to which he i s successful i n accomplishing t h i s i s l a r g e l y dependent upon the strength of those portions of the person-a l i t y which are summed up as the ego. The caseworker i s concerned with helping the c l i e n t to handle h i s r e a l i t y s i t u a t i o n i n a better way, and only the c l i e n t ' s conscious awareness of th i s i s u t i l i z e d d i r e c t l y . While the caseworker must be aware of unconscious emotional c o n f l i c t and i t s weakening eff e c t on the ego strength, such material i s not e l i c i t e d nor worked with d i r e c t l y . However, awareness of th i s i s necessary i n order to keep casework treatment within safe l i m i t s and to enable the caseworker to formulate r e a l i s t i c treatment goals with the c l i e n t . Berkowitz points outi At the outset we search for ways of helping people acquire a degree of personal achievement or ego mastery i n some important aspect of t h e i r l i v e s which - 70 -w i l l improve t h e i r s o c i a l functioning. This kind of achievement by the c l i e n t may be as varied as learning control of impulsive behaviour, making e f f e c t i v e use of a s o c i a l resource, or l i v i n g more comfortable i n a d i f f i c u l t s i t u a t i o n . . . . I t i s true that our r e s u l t s may be accomplished e n t i r e l y through a process of ego influence, with l i t t l e or no reference t o — o r c l a r i f i c a -t i o n of the past to the present, even though a substantial amount of information about the past may have been obtained f o r the purpose of diagnosis.1 Dr. Franz Alexander points out that the ego becomes, aft e r maturation, the dynamic core of behaviour. According to Freud, the ego's function i s to carry out co-ordinated r a t i o n a l behaviour, designed to maintain the i n d i v i d u a l i n a state of equilibrium with his environment. Alexander defines the tasks of the ego as follows: 1) Internal perception of i n s t i n c t i v e needs, 2) external perception of ex i s t i n g conditions upon which the g r a t i f i c a t i o n of subjective needs depend, 3 ) the integrative f a c u l t y by which the ego co-ordinates i n s t i n c t i v e urges with one another and with the require-ments of the super-ego and adapts them to environmental conditions, and 4) the executive f a c u l t y by which i t controls voluntary behaviour. Through the l a t t e r , Alexander concludes, the ego can implement the re s u l t s of i t s integrative function, which consists fundamentally i n the r a t i o n a l cognitive f a c u l t y . 2 H o l l i s elaborates oh the function of the ego as follows: The ego i s the name for that composite of q u a l i t i e s through which the i n d i v i d u a l adapts himself to the outside world, securing from i t the opportunity to express h i s fundamental drives and to meet his major 1 Berkowitz, Sidney, "Some S p e c i f i c Techniques of Psycho-s o c i a l Diagnosis and Treatment i n Family Casework," S o c i a l Casework. Vol. XXXVI, No. 9 (November 1955) , PP. 404 -405. 2 Alexander, Franz, Dynamic Psychiatry, University of Chicago Press, 1952, p. 10 . - 71 -needs. These q u a l i t i e s include the a b i l i t y to perceive external r e a l i t i e s and i n t e r n a l f e e l i n g s , the a b i l i t y to fi n d ways of meeting i n t e r n a l needs through the environ-ment i n a fashion that w i l l not only be s a t i s f y i n g but w i l l bring the minimum of discomfort to others or to himself, the a b i l i t y to foresee the outcome of various courses of action, to learn from experience, to weigh the advantages and disadvantages of his behaviour, to suppress and repress desires that cannot safely be expressed, i n general to control, d i r e c t and harness his a c t i v i t i e s . . . . I t i s the task of the ego then, to f i n d as much pleasure as possible, to avoid the creation of anger by f r u s t r a t i o n whenever possible, to protect us from both outer and inner danger i n order to avoid the development of fear and anxiety and to do a l l t h i s i n a manner that w i l l not arouse feelings of g u i l t . 1 The e f f i c a c y with whieh the ego discharges these varied duties, fluctuates i n proportion to both i n t e r n a l and external stresses that the i n d i v i d u a l i s experiencing at any given time. When a person comes to a s o c i a l agency seeking help with a problem such as marital discord, his apparent ego strength may be diminished because of the s t r e s s - s i t u a t i o n i n which he finds himself. Because of t h i s , the caseworker can only accurately assess the ego strength of a c l i e n t , by taking into consideration a h i s t o r i c a l view; how he has per-formed i n the past and solved problems i n his l i f e s i t u a t i o n . When the equilibrium between the i n d i v i d u a l and his environment i s disturbed, the ego seeks to restore the balance by the use of mechanisms of defense. As has been noted i n the previous chapter, these defensive patterns can be divided into three categories: f l i g h t , independence or 1 H o l l i s , Florence, Women In M a r i t a l C o n f l i c t . Family Service Association of America, New York, 1949, PP* 12 -13 . - 72 -dependence. In order to cope adequately, the ego must be able to employ a l l three types of defences and employ them appropri-ately. If i t cannot do this, the ego cannot effectively handle the anxiety inherent i n a threatening situation. Alexander notes: These defences are partly bulwarks which favour repression, such as over-compensation or rationalization, and partly vents by which the repudiated tendencies can find an outlet, such as projection, substitution, dis-placement, or turning impulses directed against external objects against the s e l f . l While everyone uses defence mechanisms to survive, i t is the effectiveness with which they are used that i n d i -cates the comparative health of the personality. A weak ego is often indicated, i f the person has to cling to defences appropriate only to an infantile stage of development. In assessing ego strength, the caseworker must be aware of the kinds of defences utilized by the client, their effectiveness and their r i g i d i t y . If internal stresses are high, the ego may have to employ a multitude of defences, \in a r i g i d system, in order to keep threatening impulses at bay. The use of these defences based on internal rather than external pressures, w i l l cloud his perception of rea l i t y , decrease his chance of healthy interaction with the environment and his ensuing gratifications. The c r i t e r i a selected i n this study, to evaluate ego strength were: (1) How accurately does the client per-ceive reality and how effectively does he cope with the 1 Alexander, op,, c i t . . p. 12. - 73 -environment? (2) What i s his concept of himself? These two c r i t e r i a were selected a f t e r study of p s y c h i a t r i c material pertaining to the structure and function of the ego, as being the two functions of the ego which caseworkers are competent 1 to assess. This was combined with a second element on whieh t r e a t a b i l i t y was seen to depend, namely, "Willingness to use casework treatment." Three ratings, "poor," " l i m i t e d " and "good" were described f o r each of the three c r i t e r i a selected to assess casework t r e a t a b i l i t y , and the d e t a i l s are drawn together i n Schedule 6 , page 74 ; t i t l e d , "Suggested C r i t e r i a for Evaluation of Casework T r e a t a b i l i t y . " Using these c r i t e r i a , ratings were made for each husband and wife i n the f i f t e e n cases, i n t h i s study. The r e s u l t s are shown on Table 3, page 75. In Group I, the t y p i c a l s i t u a t i o n was that the husband was rated "poor," i n both ego strength, and willingness to use the casework service. The wife's ego strength varied from poor to good, but t y p i c a l l y , her willingness to use the service was rated "good." I t would appear that the casework treatment was quite properly focussed on the wives i n t h i s group, as they 1 Alexander, op. c i t . , pp. 9-15* Saperstein, Milton R., Emotional Security, Crown Publishers, New York, 194o. - 74 -Schedule 6. Suggested C r i t e r i a for Evaluation of T r e a t a b i l i t y C r i t e r i a 17"" Percep-t i o n of r e a l i t y ; and effect tiveness of coping with en-viron-ment Poor External s i t u a t i o n d istorted by intern-a l c o n f l i c t to such a degree that he reacts inappropri-ately to many situ a t i o n s . Em-ploys many defence mechanisms when they are not t r u l y required. Unsuc-ce s s f u l i n decreas-ing anxiety and obtaining g r a t i f i c a -tions except trans-i e n t l y . Rating L i m i t e d A b i l i t y to per-ceive r e a l i t y i n some situations that do not im-pinge d i r e c t l y on in t e r n a l c o n f l i c t s Uses defence mech-anisms more appro-p r i a t e l y , but can be e a s i l y threat-ened. Obtains g r a t i f i c a t i o n from the environ-ment i n some areas. Good Perceives r e a l i t y ac-curately i n most s i t u a t i o n s , except i n .situations of exceptional s t r e s s . U t i -l i z e s defence mechanisms appropriately to deal with anxiety and restore balance. Obtains g r a t i -f i c a t i o n from environment i n s o c i a l l y acceptable way. 2. Concept of s e l f . Constantly f e e l s threatened; extreme-l y insecure i n most areas of his func-t i o n i n g . L i t t l e confidence i n a b i l i t y to plan or to d i r e c t and con-t r o l behaviour. Assumes either very dependent, very i n -dependent, or with-drawn p o s i t i o n i n realtionships to others. Goals d i s -proportionate to a b i l i t i e s . High degree of f r u s t r a -t i o n . Cannot ad-mit emotions to consciousness with-out d i s t o r t i o n . Feels adequate i n some areas and obtains some g r a t i f i c a t i o n s . Relates well to other people who can o f f e r protec-t i o n and g r a t i f i -cation. Threat-ened by new s i t u a -t i o n s , and becomes insecure when equilibrium i s disturbed. Over-reacts to these s i t u a t i o n s . Somewhat unrealis-t i c about goals but can carry some planning to completion. Sees himself r e a l i s t i c a l l y i n r e l a t i o n to other people and re-lates i n a mature way; neither too sub-missive, or too aggressive. Sets healthy l i m i t s on own behaviour and obtains pleasure from environment. Can mobilize e f f e c t i v e de-fences against his anxiety which i s r e a l i t y based. Does not over, or under react. 3. W i l l i n g -ness to use case-work. Only w i l l i n g to come once or twice to the agency to " t e l l his side," or to speak against spouse. No fee l i n g that the marital s i t u a t i o n should or could be changed; or, verba-li z e s a desire to lave the s i t u a t i o n changed but rejects sasework help. Considerable avoidance of interviews or came only when prompted by the caseworker. Con-siderable r e s i s t -ance, and ambi-valence. Some gains made but these were mini-mal or sporadic, or not carr i e d over into the home s i t u a t i o n consistently. Limited accept-ijance of own Ir e s p o n s i b i l i t y . Acceptance of the sort of help casework could o f f e r ; good ac-ceptance of l i m i t s and of own r e s p o n s i b i l i t y . Came consistently and frequently for interviews and brought s i g n i f i c a n t material to interviews. Minimum of inap-propriate reac-tions to case-worker. To follow page 74 Table 3. Assessment of Casework T r e a t a b i l i t y of Marriage Partners 1 HUSBAND WIFE Case | Ego j Strength I Willingness To Use Service Ego Strength Willingness To Use Service Group I Able Limited Poor Poor Limited Brown Poor Poor Limited Good Crocker Poor Poor Good Good Daniel Poor Limited Limited Limited Evans Limited Poor Good Good Most t y p i c a l Poor Poor (Variable) Good Group II F e l l Limited Good Limited Good Gr e n f e l l Poor Poor Poor Limited H a l l Limited Good Limited Poor ilnman Limited 1 Good Poor Poor I Jackson Limited Limited Poor Poor Most t y p i c a l Limited Good Poor Poor Group III King Limited Good Limited Good Long Poor Poor Poor Limited Manville Poor Limited Poor Good Nelson Poor Good Poor Good Ogden Limited Good Good Good Most t y p i c a l Poor Good Poor Good - 75 -were the ones who were both able and w i l l i n g to p r o f i t a b l y use casework service. In Group I I , where the treatment was mainly focussed on the husbands, t h i s again would appear to have been appropri-ate. The t y p i c a l s i t u a t i o n was that the husbands had l i m i t e d ego strength, but were very much interested i n casework help. The wives on the other hand, as a group, had poor ego strength and were unwilling to use the casework services offered. In Group I I I , where the husbands and wives p a r t i c i p a t e d equally i n casework treatment of the marital c o n f l i c t , the t y p i c a l s i t u a t i o n was that both husband and wife were scored as "poor" i n regard to ego strength* but both were scored "good" i n terms of th e i r willingness to use casework service. Thus the focus of treatment on one or the other partner or, dually on both, seems to be decided p r i m a r i l y by the c l i e n t ' s willingness to use the casework service, rather than on an assessment of the c l i e n t ' s ego strength. On the whole, considering a l l cases together, the women rated s l i g h t l y better than the men i n regard to ego strength as follows: seven rated "poor," f i v e rated " l i m i t e d , " and three rated "good." The men rated; seven "poor" and eight " l i m i t e d . " In regard to willingness to use the service, the rating of the men was very close to that of the women. Treatment Methods When the caseworker has assessed the c l i e n t ' s t r e a t a b i l i t y , a plan for treatment goals and techniques can be - 7 6 -formulated. The methods used to help the c l i e n t must be appropriate to the problem s i t u a t i o n , to the c l i e n t ' s a b i l i t y to use help and the caseworker's s k i l l with the d i f f e r e n t techniques. Except i n the case of environmental manipulation, a l l of the techniques of casework, to be e f f e c t i v e l y used, must depend on the development of a p o s i t i v e r e l a t i o n s h i p between the caseworker and the c l i e n t . The depth of t h i s r e l a t i o n s h i p may vary with the treatment method used, but i t should always offer the caseworker's understanding, warmth and concern, to the c l i e n t . Only when assured of t h i s sort of a response from the caseworker can the c l i e n t share the true nature and extent of his problem. The c l a s s i f i c a t i o n of treatment methods used 1 by Miss Florence H o l l i s i n her book "Women i n M a r i t a l C o n f l i c t " i s used i n t h i s study; and may be summarized under the following headings: 1. Environmental Modification When the c l i e n t i s unable to take action i n regard to changing h i s environment, and the caseworker can do so e f f e c -t i v e l y , t h i s may be undertaken. Any such d i r e c t intervention by the caseworker must be based on a thorough diagnostic under-standing of a l l the factors involved, and i s done only i f the c l i e n t cannot undertake such steps for himself. Usually environmental modification i s accompanied by psychological support, but the extent to which t h i s second technique i s 1 H o l l i s , op., c i t . - 77 -involved varies from case to case. 2. Psychological Support Psychological support does not seek to increase the c l i e n t ' s i n t e l l e c t u a l understanding of h i s problem although t h i s may increase as the process continues. The emphasis i s , rather, on r e i n f o r c i n g his strengths; the healthy component of his personality. This i s effected through a warm "good-parent" type of rel a t i o n s h i p between the e l i e n t and the caseworker, which i s designed to decrease tension and g u i l t , to increase self-confidence, and to encourage healthy functioning on the part of the c l i e n t . While understanding and acceptance of the c l i e n t ' s d i f f i c u l t i e s i s basic, the caseworker must be able to set l i m i t s for the c l i e n t a lso, when these are required. Where t h i s method promotes strength and growth through the experiencing by the c l i e n t of a therapeutic relationship with a worker, i t i s often c a l l e d , "experiental" therapy. 3. C l a r i f i c a t i o n C l a r i f i c a t i o n i s a process that may accompany psycho-l o g i c a l support. This technique stresses the development of increased understanding on the part of the c l i e n t . Some people have a need to approach understanding through the i n t e l l e c t rather than the emotions; and t h i s technique i s more appropriate for them than the preceding one. The increased understanding of t h e 1 c l i e n t may be i n regard to himself, other people with whom he i s associated, or anything i n h i s environment. In i t s - 78 -simplest form i t may be almost only an i n t e l l e c t u a l exchange between the c l i e n t and the caseworker. On the other hand, i t may have a strong emotional component, depending on the subject matter dealt with. 4. Insight Development This technique should only be used as the main form of treatment when competent p s y c h i a t r i c consultation i s a v a i l a b l e . I t i s used infrequently compared to the preceding two techniques described. The r e l a t i o n s h i p between the c l i e n t and caseworker i s strong, deep, and laden with a strong transference element. I t i s used for the most part, when the c l i e n t i s suffering only a mild degree of neurosis or character disturbance. The c l i e n t i s helped to a deeper understanding of how h i s inner c o n f l i c t d i s t o r t s his view of r e a l i t y . Insight development i s usually accompanied by psychological support and c l a r i f i c a t i o n . The treatment methods used with the husbands and wives i n these f i f t e e n cases are shown i n Schedule 7> page 89, t i t l e d "Treatment Techniques." Where the casework contact was such, that none of the techniques could be used, t h i s i s shown by the notation "of diagnostic value only." Three cases, one from each group, have been'selected to i l l u s t r a t e the material on which these assessments of t r e a t a b i l i t y were based, and the use of treatment techniques. Mr. and Mrs. Crocker were referred to the Family Service Agency by the Metropolitan Health nurse when i t became - 79 -apparent that t h e i r marital problems were at the root of t h e i r school-aged son's behaviour problems. They came to the agency together and the f i r s t interview was held with them j o i n t l y . From the beginning Mr. Crocker denied that there was any problem between him and hi s wife except the boy's behaviour, and, he added r e l u c t a n t l y , f i n a n c i a l problems. Although he verbalized h i s desire f o r agency help and agreed to come f o r regular interviews, he made every e f f o r t to avoid these and missed arranged appointments because he was "too busy." He was not able to accept any exploration of his avoidance, or to recognize that he did not wish to face the interviews. This pattern of avoidance was followed i n most of the areas of Mr. Crocker's l i f e . He found i t extremely d i f f i c u l t to face commitments i n regard to hi s business and continually forced h i s wife into the po s i t i o n of making excuses f o r him when creditors t r i e d to see him to make some arrangement about payment of debts. He also avoided assuming any r e s p o n s i b i l i t y i n regard to the children whether i t was d i s c i p l i n e , or some outing that he had promised them, by saying that he was too busy, he was sick, or i t was "not h i s job." He came three times to see the caseworker; twice i n the early part of the contact, obviously i n response to pressure from his wife, and once, v o l u n t a r i l y , very near to the end of the treatment period with h i s wife, seven months l a t e r . In the f i r s t two interviews he kept the conversation on a s u p e r f i c i a l l e v e l , and continued to deny the existence of marital discord. a - 80 -He obviously needed reassurance from the caseworker and spent some time ta l k i n g about himself i n a way designed to win the caseworker's approval. He was a very anxious man; f e a r f u l about his s e l f - c o n t r o l . He used the defences of de n i a l , over-compensation, repression, r a t i o n a l i z a t i o n , and projection to a marked degree. He was not able to see himself r e a l i s t i c a l l y i n r e l a t i o n to other people and f e l t either i n f e r i o r or superior to them. Because of t h i s , he was i n g r a t i a t i n g with those whom he feared and domineering with those he f e l t he con t r o l l e d . In spite of h i s elaborate defense structure, h i s behaviour at times was uncontrolled, and with very l i t t l e provocation he abused h i s wife. His rages were not r e a l i s t i c a l l y related to the environment, but obviously the expression of severe i n t e r n a l tensions from the unconscious l e v e l . When he v o l u n t a r i l y sought an interview with the caseworker, i t was a f t e r seven months i n whieh h i s wife had strengthened her own performance and been able to function i n a much more pos i t i v e manner toward him. His anxiety had decreased, and he had obviously come to make a "good report" to the case-worker. With his increased s e c u r i t y , he was able to make good use of thi s interview and discussed plans f o r the summer en t h u s i a s t i c a l l y . On t h i s occasion to, he was able to speak of his f e e l i n g of having f a i l e d h is son, and h i s desire to be a better father i n the future. Although Mr. Crocker made i t clear that he did not wish to continue the interviews, even now, fo r himself, he spoke i n a very pleased way about how much - 81 -the service had helped h i s wife, and h i s desire that the case-worker would continue with her. The f a c t that Mr. Crocker could accept the caseworker to t h i s degree at least prevented him from being f e a r f u l about h i s wife's contact, and gave him some f e e l i n g of acceptance from what he evidently considered an autho r i t a t i v e person. In addition to Mr. Crocker's present performance and his way of r e l a t i n g to the caseworker, the h i s t o r y indicated a poor prognosis, as Mr. Crocker had long followed a pattern of avoidance of d i f f i c u l t i e s , and his behaviour seemed dictated by impulse. His performance i n the marital r e l a t i o n -ship had always been very l i m i t e d , but h i s wife seemed to have been able to tolerate t h i s , u n t i l the son began to r e f l e c t the problems i n disturbed behaviour. In contrast to Mr. Crocker, Mrs. Crocker had good pot e n t i a l f o r treatment. Her ego strength was judged to be good and she used the casework interviews constructively over a period of seven months, appointments being scheduled approximately every ten days. Mrs. Crocker evidently was carrying a burden of g u i l t that was related to her unresolved Oedipal c o n f l i c t i n regard to her parents, and was being expressed i n the marital s i t u a t i o n . The fac t that her husband was twelve years her senior, and married to another woman at the time Mrs. Crocker contracted a common-law union with him, indicates acting out her desire to win father from - 82 -mother. She dated her present anxiety from the time that she had found out that her marriage to Mr. Crocker had alienated her from her church, which was Roman Catholic. This i n turn could be related to her anxiety over her mother's health and the fear that "something would happen to mother." She rejected her son at the time of hi s b i r t h , because "she coulpl not l i k e her husband at that time." That i s when she "found out what i t had cost her," ( a l i e n a t i o n from the church). Mrs. Crocker gained a great deal of r e l i e f from being able to speak of her previous common-law re l a t i o n s h i p with Mr. Crocker, which she had been unable to discuss with anyone el s e . She expressed a great deal of concern over "what the caseworker would think of her," but seemed to f e e l t r u l y accepted and reassured by the caseworker. The caseworker supported her desire to be a good wife and mother and gave Mrs. Crocker confidence that she could deal with day to day situations as they occurred. Help was given i n understanding the ch i l d ' s behaviour and concrete suggestions around handling of t h i s were given. At Mrs. Crocker's request, an appointment was arranged f o r her with a p r i e s t , who again gave acceptance and understanding, affirming Mrs. Crocker's strengths and underlining her duties as a wife and mother. The caseworker had discussed Mrs. Crocker's problem with the p r i e s t previously, to further his understand-ing of the s i t u a t i o n . Mrs. Crocker was helped to modify her rather " i d e a l " concept of her ro l e as wife and mother and to f e e l less g u i l t y about her negative f e e l i n g s , a l s o . Her - 83 -anxiety decreased as she was able to meet some of her dependency needs i n the relat i o n s h i p with the worker and her performance i n the home strengthened. In the re l a t i o n s h i p with the worker transference elements were apparent, and approval from a mother figure seemed to dissipate a consider-able amount of g u i l t and fear. Both these people wished to preserve the marriage, and as I r s . Crocker was able to give more a f f e c t i o n to her husband, he responded to her by improving his own performance to conform more c l o s e l y to her standards. Although Mrs. Crocker had underlying emotional problems that remained untouched by the casework treatment, a s a t i s f y i n g balance i n the marriage was restored. She had good perception of r e a l i t y and a b i l i t y to cope with problems when the stress was not too great. She related i n a p o s i t i v e way, and used the caseworker constructively f o r support. Her defenses were not r i g i d nor inappropriate and she could mobilize h e r s e l f to handle problems once these were c l a r i f i e d with her, and she was supported i n taking the necessary steps. Part of her i n t e r n a l c o n f l i c t seemed to come from e f f o r t s to deal with a s t r i c t super-ego. The caseworker helped by functioning as an external, more permissive, super-ego, which the c l i e n t might, through rel a t i o n s h i p and i d e n t i f i c a t i o n , also p a r t i a l l y i n t e r n a l i z e . Mr. H a l l came to the agency seeking help i n arranging a r e c o n c i l i a t i o n with h i s wife, who had recently l e f t him, taking t h e i r two and a h a l f year old son with her. Mr. H a l l - 84 -was extremely anxious; i t appeared that his wife's desertion had shattered his defenses against h i s fearfulness about h i s masculinity. Much i n t e r n a l stress was evident, and although Mr. H a l l was able to perform well i n some aspects of his l i f e , such as employment, he was not sure about h i s continuing a b i l i t y to do so, doubted h i s controls, and was conscious of strong feelings of apprehension and fearfulness. He recog-nized that his h o s t i l i t y to others, p a r t i c u l a r l y older men was very t h i n l y v e i l e d and handling t h i s , gave him some discomfort. He used the defences of repression, s u b s t i t u t i o n , projection, r a t i o n a l i z a t i o n and conversion, to a marked degree. Although h i s ego strength was l i m i t e d , h is willingness to use the service was good. He related quickly to the case-worker and was able to f e e l safe i n a dependent re l a t i o n s h i p with him. He took the i n i t i a t i v e i n arranging appointments and was seen twice a week f o r a considerable period. When he became less anxious these appointments were spaced at once a week, then once every two weeks, and continued f o r a period of over a year. He accepted l i m i t s which were necessarily imposed on his use of the caseworker's time, w e l l . Mr. H a l l related to the caseworker as to a good father. With support and acceptance from the caseworker Mr. H a l l was able to abandon some of his destructive defences and to strengthen the use of others that were constructive. He began to see his own involvement i n the marriage problem, and the relationship of his personality patterns to t h i s was c l a r i f i e d with him. Strengthened by the fact that many of his dependency needs were being met by the - 8 5 -caseworker, he was able to re l a t e i n a more mature way to h i s wife; be more tolerant of her problems and needs, o f f e r i n g her more understanding but at the same time imposing more r e a l i s t i c l i m i t s , consistently and o b j e c t i v e l y . He was able to recognize that some of h i s suspicions and anxieties about her were u n r e a l i s t i c , and part of h i s t o t a l f e e l i n g about women; and to control these fee l i n g s instead of acting on them. Mrs. H a l l was considered to have poor p o t e n t i a l f o r treatment. She was rated " l i m i t e d " i n ego strength. Her defense pattern was that of withdrawal and excessive -independence, to handle the anxiety engendered i n the marital r e l a t i o n s h i p . She evidently was weakly oriented to a hetero-sexual rel a t i o n s h i p and found i t d i f f i c u l t to accept her husband's desire that she assume a dependent r o l e . Unable to express her h o s t i l i t y , she reacted with depression. After being seen twice by the male caseworker who interviewed her husband, she was transferred to a female case-worker. With both caseworkers she showed a great deal of resistance. She kept the conversation to s u p e r f i c i a l i t i e s , and was very c o n t r o l l i n g throughout the interviews. She was unable to accept c l a r i f i c a t i o n around her own involvement i n the formation of the problems between her and her husband and continued to project the r e s p o n s i b i l i t y f o r the breakdown i n the marriage on him. Because of her great need for independence she was not able to use, e f f e c t i v e l y , support given by the caseworker. - 86 Both Mr. and Mrs. Nelson were considered to have - poor ego strength but were rated good i n willingness to use ' the service. Both these people had a great deal of i n t e r n a l emotional stress that was being projected onto the marriage r e l a t i o n s h i p . Mr. Nelson needed a f r i g i d r e j e c t i n g wife to protect him from his castration anxieties which stemmed from his unresolved fears about h i s father, and Mrs. Nelson needed an unsuccessful male on whom she could vent the rage she t r u l y f e l t for her own father. In both these people, the ego strength was i n s u f f i c i e n t to handle the i n t e r n a l stress and the c o n f l i c t was projected onto the external environment to such an extent that the environment was d i s t o r t e d , and t h e i r perception of r e a l i t y was poor. Mr. Nelson f e l t insecure and h o s t i l e with everyone, but struggled constantly to repress his h o s t i l i t y . Because of his fearfulness of his own aggression and h o s t i l i t y he turned a great portion of t h i s against him-s e l f , as being the safer a l t e r n a t i v e , and made himself the victim of numerous accidents at work; psychogenic headaches and stomach i l l n e s s . He was conscious of a constant f e e l i n g of fear and depression. Mrs. Nelson saw herself as being at the mercy of a brutal husband and an unsuccessful suppliant for help from authority figures i n the environment. She was unable to ask for help for h e r s e l f but asked continually for help for her husband. Again her a b i l i t y to perceive the environment - 8 7 -r e a l i s t i c a l l y was very poor. She used conversion defences also, and was very much preoccupied with a legion of i l l n e s s which seemed to have no physical basis. Both of these people came regu l a r l y , once a week to see the caseworker over a period of months. Some attempts at environmental modification were carried out. Mr. Nelson was referred to a Vocational Counsellor for a r e a l i s t i c assessment of his a b i l i t i e s i n the area of employment. Although the res u l t s were very good and he scored very high on these t e s t s , he was unable to mobilize himself to eff e c t any change i n the work area. Mrs. Nelson was referred for p s y c h i a t r i c assessment, and her co-operation i n t h i s was gained by the caseworker's i n t e r p r e t a t i o n to the family doctor, who i n turn interpreted to Mrs. Nelson that she needed psy c h i a t r i c help for h e r s e l f . A diagnosis of possible schizophrenia was made and e f f o r t s continued to help Mrs. Nelson move towards treatment of her i l l n e s s . Although Mrs. Nelson verbalized her acceptance of this c l a r i f i c a t i o n of her problem, she was not s u f f i c i e n t l y mobilized to seek help. Her husband also, verbally accepted t h i s c l a r i f i c a t i o n of part of the problem, but his need to keep his wife as a protective shi e l d for his own neurotic fears was so great, that he, i n f a c t , gave no support to the plan. Some f i n a n c i a l assistance was given to the family at c r i s i s points. Mr. Nelson slowly responded to c l a r i f i c a t i o n of his need to c l i n g to a punishing wife and to verbalize h i s fear that he could not survive with-out her. He responded s l i g h t l y to the caseworker's e f f o r t s to - 88 -help him test out h i s true strength i n handling the environ-ment. After a period i n which Mrs. Nelson seemed to be considering moving towards p s y c h i a t r i c treatment for he r s e l f she withdrew and continued to project her d i f f i c u l t i e s onto environmental problems which she continued to perpetuate. Both Mr. and Mrs. Nelson used the worker to meet some of t h e i r dependency needs, but also constantly t r i e d to a l l y the worker i n th e i r mutual b a t t l e . They frequently di s t o r t e d the caseworker's words to use as weapons, one against the other, and were never able to verbalize t h e i r true feelings to the worker. The techniques used were primarily support and environmental modification, with some attempts at c l a r i f i c a -t i o n . The c l a r i f i c a t i o n followed the d i r e c t i o n given by the psy c h i a t r i c consultant. In Group I, where most of the treatment was c a r r i e d out with the wives, the techniques used were psychological support and c l a r i f i c a t i o n , i n each case. The proportionate use of each technique varied from case to case. In some cases, the component of i n t e l l e c t u a l c l a r i f i c a t i o n was high, i n others the main t o o l of the caseworker was the supportive r e l a t i o n s h i p , which gave the c l i e n t a new and strengthening experience. The f i v e husbands i n t h i s group were treated by means of psychological support i n four cases; i n one case the contact was considered of diagnostic value only; the c l i e n t was mentally i l l . In one case environmental modification was - 89 -Schedule 1. Treatment Techniques Technique Accorded to Husband Wife Group I 1. Environmental Modification j 2 . Psychological Support 3 . C l a r i f i c a t i o n 4. Insight Development 1 5. Diagnostic only D A,C,D,E B C,D A,B,C,D,E A,B,C,D,E E Group II 1. Environmental Modification 2 . Psychological Support 3 . C l a r i f i c a t i o n 4. Insight Development 5. Diagnostic only F,G,H,I,J F,H,I,J H F,G,H F I,J Group III 1. Environmental Modification 2 . Psychological Support 3 . C l a r i f i c a t i o n 4. Insight Development 5. Diagnostic only N K,L,M,N,0 • | K,M,N,0 ! | N K,L,M,N,0 K,L,M,N,0 i - 90 -also attempted. The l e v e l of treatment used with the husbands and wives would seem to be appropriate to the estimate made e a r l i e r of t h e i r t r e a t a b i l i t y . In thi s group, the husbands were seen to have a low p o t e n t i a l f o r casework treatment, and i t i s un l i k e l y that they could have responded to any technique more threatening than psychological support. In Group I I , where the casework treatment was mainly car r i e d out with the husbands, the techniques of psycho-l o g i c a l support and c l a r i f i c a t i o n were used together, i n case-work with four of the men. In one case, there was some insight development, a l s o . In one case, psychological support only, was the treatment used. This was i n the case of Mr. G r e n f e l l , who was rated "poor" i n ego strength and "poor" i n willingness to use the service. The other four men were a l l considered limited i n ego strength; one was rated as lim i t e d i n terms of his willingness to use the service, and the other three were rated good. The f i v e wives i n thi s group had a much lower p o t e n t i a l for treatment. The treatment methods used, i n working with them, were, therefore, appropriately confined to psychological support i n two cases, and i n one c l a r i f i c a t i o n was used, i n a limited sense, together with psychological support. In two cases, the contact with the wives was considered to be of diagnostic value only. In Group I I I , where the casework treatment was focussed dually on the husbands and wives, psychological support was combined with c l a r i f i c a t i o n i n four cases with the - 9 1 -men, and i n a l l cases with the women. In one case, environmental modification was combined with support and c l a r i f i c a t i o n , and, i n one case, only support could be used with one of the husbands. Thus the techniques employed i n treatment i n these cases can be seen to depend on the assessment of the c l i e n t ' s p o t e n t i a l f o r treatment, and the sort of help that the c l i e n t can best u t i l i z e . I t i s important that the diagnosis be accurate and that the treatment methods be appropriately used. The caseworker must be aware of the c l i e n t ' s a b i l i t y or lack of i t to use c l a r i f i c a t i o n and i n s i g h t , so that the opportunities possible from these techniques w i l l not be denied the c l i e n t . In some cases, although c l a r i f i c a t i o n of the true problem seems obvious, i t s e f f e c t on the c l i e n t would be disastrous and the caseworker should be c a r e f u l to give the less threatening support or modification of the environment. CHAPTER 4 MOVEMENT IN MARITAL CONFLICT CASES Any i n d i v i d u a l i s i n constant i n t e r - a c t i o n with h i s environment; movement and change are inherent i n l i f e . In every i n d i v i d u a l , the p u l l toward dependency or i n a c t i v i t y , Is opposed by the p u l l toward achievement and a c t i v i t y . In case-work treatment, the caseworker meets as much of these dependency needs as i s r e a l i s t i c a l l y possible, but constantly supports and encourages the c l i e n t to u t i l i z e his strengths to gain s a t i s f a c t i o n s i n more comfortable, s e l f - r e l i a n t function-ing. Everyone does not have the same p o t e n t i a l for indepen-dent functioning however, and the c l i e n t must be helped to achieve at his own rate rather than according to some pattern of s t a t i c perfection. Accordingly, the caseworker seeks to help the c l i e n t to a t t a i n p o s i t i v e movement or growth i n terms of h i s a b i l i t y to handle the problems posed to him by the environ-ment. But while the course of casework treatment i s i n progress, external events may impinge on the c l i e n t , acting as aids or deterrents to t h i s p o s i t i v e movement. The amount of movement an i n d i v i d u a l c l i e n t achieves varies from case to case. Movement may vary i n d i r e c t i o n as well as degree; that i s , the movement may be po s i t i v e or retrograde. In the evaluation of any treatment program, an - 93 -assessment of movement achieved by the c l i e n t s i s imperative, as t h i s i s the test of the effectiveness of the treatment services. Such an evaluation would, hopefully, lead to enlightenment concerning which factors aided p o s i t i v e move-ment and which factors prevented i t . A subjective form of evaluation i s made from time to time by caseworkers i n regard to each case, i n order to confirm or c l a r i f y diagnosis, treatment techniques and t r e a t -ment goals. As these cases are presented by the worker i n supervision, the evaluation becomes more objective. This i s part and parcel of casework p r a c t i c e . In recent years, research into t h i s problem of measurement of movement i n s o c i a l casework practice i s gradually aiding the development of accurate, objective and standardized methods. Perhaps the best known of these tools for measurement i s the Movement Scale developed by Hunt and 1 Kogan. In the present study, the assessments of movement i n regard to the i n d i v i d u a l marriage partner has been experimented i n , by an adaptation of t h i s movement scale. Movement i s defined as the change which occurs i n a c l i e n t , and/or his environmental circumstances during the period of casework treatment. The Hunt and Kogan scale measures move-ment per se rather than movement for which casework i s responsible. 1 Hunt, J . McV., and Kogan, Leonard S., Measuring Results i n S o c i a l Casework, Family Service Association of America, 1950. - 94 -Pour categories of evidence, i n regard to movement, are considered i n t h i s rating scale. These are: 1. Changes i n adaptive e f f i c i e n c y . This category includes such items as 'changed a b i l i t y to get along with other people, changed e f f i c i e n c y i n running a home, a c q u i s i t i o n of new job s k i l l s , and changes i n overt competence i n any other area.' 2. Changes i n disabling habits and conditions. This category includes such items as 'changes'in a t t i t u d e s , personality t r a i t s , and behaviour which i s i n i m i c a l to good s o c i a l r e l a t i o n s , changes i n delinquent tendencies, and changes i n l e v e l of anxiety, i n basic motivation, and i n health.' 3. Changes i n attitude or understanding as evidenced from the c l i e n t ' s v e r b a l i z a t i o n . This category includes such items as 'accepting counsel, changes i n att i t u d e toward s e l f and others as shown i n what the c l i e n t says, changes i n attitudes toward and understanding of community resources and the discernment of relationships between present behaviour and feelings and i n events i n the c l i e n t ' s personal past.' 4. Changes i n the environmental s i t u a t i o n . This category includes such items as 'changes i n l i v i n g quarters, clothes and furnishings, changes i n the behaviour of other people toward the i n d i v i d u a l , and changes r e s u l t i n g from c h i l d placement or the i n s t i t u -t i o n a l i z a t i o n of a psychotic.'1 Each c l i e n t ' s movement i s studied by rating his performance and s i t u a t i o n i n regard to these four categories of factors and locating i t on a scale of seven i n t e r v a l s . The mid-points of these i n t e r v a l s are numbered, thus: +4, +3, +2, +1, 0, -1, -2. +4 i s the score denoting the largest amount of pos i t i v e movement or improvement, and i s i l l u s t r a t e d by an "anchor case." +2 degree of upward movement i s about one-ha l f the change of +4 ; the status of the c l i e n t should be 1 Hunt and Kogan, Measuring Results i n S o c i a l Casework, p. 12. - 95 -d i s t i n c t l y better i n several areas at closing than at open-ing the case. +2 i s i l l u s t r a t e d by an "anchor case." + one degree of upward movement should be i n a range approximately h a l f that of +2; the status of the c l i e n t should appear c l e a r l y better i n some aspect or aspects at cl o s i n g than at opening. 0 degree may mean "no net movement"; the status of the c l i e n t i s e s s e n t i a l l y the same at closing as i t was at opening, or else gains i n one area are balanced by losses i n another. This degree i s also i l l u s t r a t e d by an "anchor case". -1 degree of downward movement i s the amount of deterioration i n a range approximating h a l f that i l l u s t r a t e d for - 2 . The status of the c l i e n t should appear worse at closing than at opening, but the de t e r i o r a t i o n should show i n fewer areas or be less severe than that i n the anchor case for - 2 . -2 degree of downward movement. The status of the c l i e n t should appear d i s t i n c t l y worse i n several aspects at closing than at opening. Although a l l four types of evidence for deteriorative change need not be present, d e f i n i t e decrease i n adaptive e f f i c i e n c y or increase i n disabling habits and conditions must be present. This i s i l l u s t r a t e d by an anchor case. Each c l i e n t i s judged i n terms of his own movement and not i n terms of any absolute standard of achievement; and independently of the degree to which he reached treatment - 96 -goals set by the worker. Thus one i n d i v i d u a l , r a t i n g +4, i f he started lower at the opening of the case, might a c t u a l l y be more poorly adapted to the environment than one who rated +2. Presumably, p o s i t i v e movement by one or both of the marriage partners could e f f e c t an improvement i n the marital re l a t i o n s h i p between them, or could cause the d i s s o l u t i o n of the marriage. Any d i r e c t c o r r e l a t i o n i n degree of change cannot be assumed. In the present study, the method attempted i s to make as objective a judgement as possible i n regard to change i n the marital r e l a t i o n s h i p , using that developed by 1 Miss H o l l i s i n her book, "Women i n M a r i t a l C o n f l i c t . " Miss H o l l i s distinguishes here, three degrees of change i n marriage adjustment, namely* "considerable improve-ment," "some improvement," and "no improvement." These c l a s s i f i c a t i o n s are based on the degree of change rather than the absolute state of the marriage a f t e r treatment. In th i s respect her method of measurement i s similar to the Hunt Kogan Movement Scale. For example, one case rated "consider-able improvement," at the end of casework treatment, might s t i l l by absolute standards, be a less "happy" marriage than another rated "somewhat improved" or "no improvement," i f there was much more d i f f i c u l t y i n the marriage, at the open-ing of the case. 1 H o l l i s , Florence, Women i n Ma r i t a l C o n f l i c t . Family Service Association of America, New York, 1949. - 97 -Miss H o l l i s considered the following changes i n one or both partners to be evidence of improvement: lessen-ing of h o s t i l i t y toward partner; lessening of anxiety caused by the marriage; reduction of suffering caused by the marriage; increase i n pleasure i n the marriage. The degree of estimated permanence of these changes also influenced the placing of a case i n the "some-what improved" or "considerable improvement" category. I f some hazard to the marriage was a c t u a l l y removed or counter-balanced or i f a d e f i n i t e improving step such as a constructive separation was taken, and held to, or i f there was s u f f i c i e n t increase i n understanding to make i t seem l i k e l y that the change would hold, the case was c l a s s i f i e d "considerable improvement." Real evidence of change had to be shown by actual behaviour either reported by the c l i e n t or observed by the worker. These p r i n c i p l e s were also applied to cases which resulted i n separation. The separation was considered an improvement, i f i t resulted i n greater happiness or less h o s t i l i t y , anxiety and/or suffering to both partners, or to one partner and not to the detriment of the other. I f the separation resulted i n improvement f o r one partner, but increased the d i f f i c u l t i e s of the other, the case was considered to be within the "no improvement" category. These d e f i n i t i o n s of the degrees of improvement have been used i n t h i s study, with an anchor case selected to - 98 -i l l u s t r a t e each category. The other twelve cases were then matched to these anchor cases, and were rated accordingly. (See Schedule 8 , page 108, t i t l e d "Movement, and Improvement i n the Marriage.") "No improvement" The Nelson Case The Nelson case has already been discussed i n Chapter 3 i n terms of t h e i r t r e a t a b i l i t y and treatment methods used by the caseworker. Mr. and Mrs. Nelson were interviewed very frequently for a period of more than a year. They came, i n the beginning, for help with the f i n a n c i a l s i t u a t i o n , but each quickly moved into a discussion of the disturbed behaviour of t h e i r spouse. F i n a n c i a l a i d for the family was obtained, but the s i t u a t i o n remained as pre-carious as ever, with new debts simply taking the place of the old. Mrs. Nelson's need for ps y c h i a t r i c treatment was c l a r i f i e d with both partners. Mrs. Nelson considered admit-tin g herself to a mental h o s p i t a l for treatment but was ambi-valent about so doing and received no support from her husband i n regard to t h i s plan. Although Mr. Nelson recognized the problem, his neurotic need f o r t h i s h o s t i l e wife was so great that he could not mobilize himself to take any step that would e f f e c t his wife's committal. The emotional r e l a t i o n s h i p between the partners seemed to deteriorate; with more overt h o s t i l i t y and more anxiety i n both partners. F i n a l l y , - 99 -Mr. Nelson, who had taken a job out of town, returned home less and less frequently. He became involved with another woman and began to drink heavily. Mrs. Nelson seemed to sense her loss of control over her husband and moved, with the children, to her husband's parents' home i n another province. Since making t h i s move, she has written to the caseworker saying the move had been a mistake, and asking to be referred to the Family Service Agency i n that c i t y . Her l e t t e r s seem to indicate further d e t e r i o r a t i o n i n her mental health. This case was placed i n the "no improvement" category as the separation had only increased both marriage partners' anxiety and s u f f e r i n g . While the p s y c h i a t r i c consultant had seen separation as a constructive step for these two people, i t was also f e l t that p s y c h i a t r i c treatment for both was e s s e n t i a l . Some improvement i n the future may be possible, as Mr. Nelson i s at least testing out his a b i l i t y to l i v e without h i s wife, who used him only as a target f o r her h o s t i l i t y . Because of t h i s attempt on Mr. Nelson's part to emancipate himself from the neurotic marriage, he was rated plus one i n terms of his i n d i v i d u a l movement. Because Mrs. Nelson's behaviour became more disoriented and confused, she was rated -1. She may, i n the future, be forced to accept ps y c h i a t r i c treatment, by her mounting anxiety. However, during the period that the case was open, 1G0 -no improvement on the marriage relationship could be observed. There were two other cases placed i n t h i s category* the Daniel case and the Inman case. The Daniel Case The Daniel case had been opened twice previously by the Family Service Agency. The marital relationship was very deteriorated with acute c o n f l i c t i n a l l areas. Both partners seemed to be very disturbed people, with l i t t l e a b i l i t y to use casework help, and l i t t l e motivation f o r change. Both continued to project the r e s p o n s i b i l i t y for f a i l u r e i n the marriage, on t h e i r spouse. In spite of t h e i r verbalized d i s s a t i s f a c t i o n , they seemed locked i n neurotic c o n f l i c t . Mr. Daniel was rated -1 i n terms of i n d i v i d u a l movement and Mrs. Daniel was rated no movement. The Inman Case In the Inman case, Mrs. Inman was rated no movement* she was seen once and expressed her desire to keep things as they were and her b e l i e f that she could not change. Mr. Inman was seen three times and seemed to gain release from his g u i l t feelings and to be able to consider his marriage more objectively. He was rated +1 i n terms of his i n d i v i d u a l movement. The marriage rel a t i o n s h i p was considered to have shown "no movement" however, as Mr. Inman withdrew from case-work treatment at th i s point, before any change i n the relationship could be observed. - 101 -"Some Improvement" The Crocker Case Mr. and Mrs. Crocker came to the Family Service Agency seeking help with the marital problems which, they had been advised, were producing the disturbed behaviour of one of th e i r sons. Mr. Crocker was not able to accept the fact that there was emotional c o n f l i c t between himself and h i s wife. He was seen three times by the caseworker, and was rated "no movement" i n regard to his i n d i v i d u a l adjustment. In discus-sion, Mrs. Crocker was able to see her own contribution to the c o n f l i c t situations at home, i n regard to her husband and the children. Gradually she was able to speak of her strong feelings of g u i l t about the marriage, and to re l a t e t h i s to her f e e l i n g of anxiety and tenseness which dictated her behaviour at home. She was able to see that her behaviour was such that she often provoked her husband's h o s t i l i t y . She verbalized her wish to be punished for the " s i n " she f e l t she had committed i n l i v i n g with and l a t e r marrying t h i s man. (Because Mr. Crocker had been married before and divorced, Mrs. Crocker had been alienated from her church by her marriage.) She was able to f i n d r e l i e f from much of t h i s g u i l t through the acceptance and approval of the caseworker; and f i n a l l y , a f t e r a period of several months with the case-worker's help, she discussed the s i t u a t i o n with a p r i e s t . - 102 -Although she could not be re-instated i n her church, the p r i e s t was able to give her considerable comfort, underlined the positives i n the s i t u a t i o n , and emphasized her s o c i a l r e s p o n s i b i l i t i e s i n regard to her husband and the children. Thus strengthened, she was able to be much more accepting of her husband, and to f e e l more p o s i t i v e l y toward him. She also improved her rel a t i o n s h i p to the children, and became more ef f e c t i v e i n handling her husband's competition with the children, f o r her attention. She was much more relaxed, happier, and more confident at the end of the casework t r e a t -ment. Her reports of the improved s i t u a t i o n at home were confirmed by her husband when he came i n , v o l u n t a r i l y , for an interview toward the end of the contact. Mrs. Crocker was rated +2 i n i n d i v i d u a l movement and the marriage was con-sidered to show "some improvement." I t was placed i n t h i s category rather than "considerable improvement" as Mrs. Crocker s t i l l had c o n f l i c t about the marriage that could not be reached by casework techniques, and some g u i l t and anxiety would continue to a r i s e . Also, since Mr. 'Crocker had not increased his understanding or changed hi s adjustment, he would continue to present r e a l d i f f i c u l t i e s i n the marriage. However, at that time, he was responding p o s i t i v e l y to Mrs. Crocker's increased a b i l i t y to meet his needs. Seven cases, i n a l l , were placed i n thi s category, namely; - 103 -Group I. Mr. and Mrs. Able Mr. and Mrs. Crocker Mr. and Mrs. Evans Group II. Mr. and Mrs. Grenfell Mr. and Mrs. Jackson Group III. Mr. and Mrs. King Mr. and Mrs. Long In a l l of these cases, but one, there was positive movement on the part of one partner but no movement on the part of the other. In one case, both partners were rated +1 individual movement. "Considerable Improvement" Ogden Case Mr. and Mrs. Ogden were referred to the Family Service Agency for help with the marital problems, by Child Guidance Clinic , where they had sought help with the problem behaviour of their oldest son. They were separated at, that time, hut were considering reconciliation "for the sake of the children." Mr. Ogden was projecting a l l of the blame for the deterioration in the marriage, on his wife, saying that she was a dependent child rather than a woman. His attitude was that his behaviour, on the other hand, had been reasonable and that he had done everything that he could to "make his wife over" and to make the marriage succeed. Mrs. Ogden had lost a l l of her feeling of self-worth and was unable she said, to trust her own reason, since she always appeared to be in the wrong. She wanted her husband back at any price but wondered i f she could live in a - 104 -situation that was so unhappy for her. Both partners said they had had d i f f i c u l t y since the beginning of the marriage ten years ago; they had been separated for approximately a year. Casework treatment was carried on for a period of one year, with the focus dually on bo;th partners. During this period, Mr. Ogden moved back with his wife and children, and installed the family in a much larger and adequate house. He was encouraged to make this move only i f he could see more positives in the reconciliation than i t s being "for the children's sake." He was able to see that he wanted to be part of a family group; that he "did not want to end up alone," and that i f he were to avoid this self-imposed isolation he must re-examine and try to improve his relationship with his wife. He gained insight into his way of relating to others and the fact that this pattern of isolation pervaded a l l of his relationships; that he "was too hard on other people and too hard on himself." He was able to become more relaxed and, with this, less demanding. In discussion with the caseworker, he was able to bring out positives in regard to his wife and to see that he had had a need to devalue her. He said he was seeing her differently now as he "saw her through your (the caseworker's) eyes." He restored to Mrs. Ogden many of the areas of responsibility that he had formerly denied to her, and for the f i r s t time in several years, they began to share interests and - 105 -activities together. Mrs. Ogden, who had handled her anxiety by a retreat into dependency and depression, quickly regained some feeling of self-esteem and confidence i n her own a b i l i t i e s , as she experienced the caseworker's acceptance and approval. She was able to express some of her h o s t i l i t y concerning her husband, rather than turning i t against herself. As she made fewer demands on him for the affection and support he could not give, his attacks on her became less frequent and less devastating. Mrs. Ogden was helped to gain an understanding of her husband's behaviour and became more tolerant of his shortcomings and less threatened by them. She was able to recognize that her husband was not able to give her a l l of the things that she wanted i n an emotional relationship, and the relationship had been further strained by her unrealistic and excessive dependency on him. In spite of some continuing lacks, she was able to recognize that her husband did provide her with many of the things that were important to her, and to see the relationship i n better perspective. Her a b i l i t y as a housekeeper increased* she was able to be more aware of the children's needs and to function as a better mother, and her depressions almost disappeared. She became hopeful about the future and confident that she "would not hit rock bottom again, no matter what happened." She said her husband was pleasanter to her now than he had been at any time during the marriage, and she f e l t more his equal. 106 -Mr. Ogden was rated +2 i n h i s i n d i v i d u a l movement; Mrs. Ogden was rated +3. Five cases out of the f i f t e e n were rated "consider-able improvement." Group A. Mr. and Mrs. Brown Group B. Mr. and Mrs. F e l l Mr. and Mrs. H a l l Group C. Mr. and Mrs. Manville Mr. and Mrs. Ogden Some of the cases showed "considerable improvement" even when the focus was primarily on one partner, as i n Groups A and B. However, i n every such case, there was movement on the part of both partners, rather than just one partner. The l a t t e r was primarily the case i n the "some improvement" category. In one of the cases of "considerable improvement" the male partner's movement was -2, while the female partner's movement was +4. This was the Brown case, i n which Mrs. Brown was able'to recognize and to deal with the f a c t of the husband's mental i l l n e s s . She had him committed for treatment and functioned constructively toward him through t h i s , s t i l l s t r i v i n g to preserve the marriage, but on a much healthier basis. She used the caseworker's help to e f f e c t t h i s , and l a t e r accepted r e f e r r a l to a p s y c h i a t r i s t to seek help with her deeper emotional problems which had lead her to submit to her husband's paranoidal domination. Because the marriage was fraught with intense c o n f l i c t at the opening of the ease, and - 107 -such e f f e c t i v e steps, which seemed to promise permanent improvement had been taken by Mrs. Brown, the case was considered to warrant "considerable improvement" c l a s s i f i c a -t i o n . Thus, reviewing a l l f i f t e e n cases; improvement i n the marital relationship did not seem d i r e c t l y correlated to the focus of treatment on either partner or on both. A l l categories of improvement existed i n a l l three groups. How-ever, improvement did seem to be related to i n d i v i d u a l move-ment. I f both partners were rated pos i t i v e i n d i v i d u a l move-ment, i n most cases, "considerable improvement" i n the marriage adjustment occurred. I f only one partner was rated positive i n d i v i d u a l movement, i n most cases, only "some improvement" occurred i n the marriage r e l a t i o n s h i p . P o s i t i v e movement was much greater on the part of the wives when they were the focus of treatment, and on the part of the husbands, when work with them was the primary focus. In the cases where the focus was dual; on husband and wife, the movement on the part of the marriage partners was similar i n d i r e c t i o n and degree. There was "no improvement" i n 20 per cent of the cases; "some improvement" i n 46 .7 per cent of the cases; "considerable improvement i n 33 • 3 Per cent of the cases. Factors Influencing Movement Achieved by the Male Partner The question of what factors influenced movement, contributing to success or f a i l u r e , i n a case, follows l o g i c a l l y once an appraisal of movement has been made. These - 1 0 8 -Schedule 8 . Movement, and Improvement i n the.Marriage Cases Male P a r t n e r Female P a r t n e r M a r i t a l R e l a t i o n s h i p 1 . Able 0 + 1 some improvement 2 . Brown - 2 +4 c o n s i d e r a b l e improvement 3 . Crocker o + 2 some improvement 4. D a n i e l - 1 0 no improvement 5 . Evans 0 + 2 some improvement Average s i t u a t i o n - 0 . 6 + 1 . 8 some improvement 6 . F e l l + 2 + 1 c o n s i d e r a b l e improvement 7 . G r e n f e l l + 1 0 some improvement 8 . H a l l + 3 + 1 c o n s i d e r a b l e improvement 9 . ' Inman 0 no improvement 1 0 . Jackson • + 1 0 some improvement Average | s i t u a t i o n + 1 . 6 + 0 . 4 some improvement 1 1 . King + 1 + 1 some improvement 1 2 . Long 0 + 1 some improvement 1 3 . M a n v i l l e + 1 + 2 c o n s i d e r a b l e improvement L4. Nelson 1 + 1 - 1 no improvement L5. Ogden + 2 + 3 " c o n s i d e r a b l e improvement Average s i t u a t i o n + 1 . 0 • i . 2 some improvement - 1 0 9 -two q u e s t i o n s ; how t o measure movement, and what i n f l u e n c e s movement, a r e s u b j e c t s o f i n t e n s i v e s t u d y by r e s e a r c h 1 workers i n s o c i a l work t o d a y . W h i l e a d e t a i l e d a n a l y s i s i s beyond t h e scope o f the p r e s e n t t h e s i s , c e r t a i n f a c t o r s seemed r e l a t e d t o t h e degree o f movement i n t h e s e f i f t e e n cases and w i l l be d i s c u s s e d i n t h e f o l l o w i n g pages. The f a c t o r s w h i c h appeared, from t h e m a t e r i a l i n t h e s e r e c o r d s , p o s s i b l y p e r t i n e n t , were as f o l l o w s . 1. R e l a t i v e a b i l i t y o f the p a r t n e r s t o p e r c e i v e problems 2. Performance i n t h e husband i n the m a s c u l i n e r o l e 3. The p a t t e r n o f t h e m a r i t a l r e l a t i o n s h i p ( t h e problem of e x c e s s i v e dependency) 4 . Ego s t r e n g t h 5. W i l l i n g n e s s t o use casework s e r v i c e 6. The p a r t n e r who came f i r s t t o agency Sex o f t h e caseworker . R i v a l r y between the spouses f o r t h e caseworker 9. Casework t e c h n i q u e s used 10. A t t i t u d e o f spouses t o each o t h e r and t o t h e m a r r i a g e . The cases were re g r o u p e d from S c h e d u l e 8, a c c o r d i n g t o t h e degrees o f movement; " r e t r o g r a d e movement," "no move-ment," " m i n i m a l movement" (+1), and " d i s t i n c t movement" (more t h a n +1). T a b l e 4 on t h e f o l l o w i n g page p r e s e n t s a comparison of t he men and women as t h e y were l o c a t e d i n t h e s e groups. The d i s c u s s i o n w i l l be l i m i t e d t o the male p a r t n e r . 1 P r e s t o n , M a l c o l m G., Mudd, E m i l y H., and F r o s c h e r , H a z e l B., " F a c t o r s A f f e c t i n g Movement i n Casework," S o c i a l Casework. V o l . XXXIV, No. 3, March 1953-To follow page 109 Table 4. Cases grouped According to the Degree of Movement (Based on Schedule 8) Men Women Retrograde Movement Mr. Brown Mrs. Nelson Mr. Daniel No Movement Mr. Able Mrs. Daniel Mr. Crocker Mrs. Gr e n f e l l Mr. Evans Mrs. Inman Mr. Long Mrs. Jackson Minimal Movement Mr. Gre n f e l l Mrs. Able (+1) Mr. Inman Mrs. F e l l Mr. Jackson Mrs. H a l l Mr. King Mrs. King Mr. Manville Mrs. Long Mr. Nelson Distinct-Movement Mr. Ogden Mrs.. Brown (+2 or more) Mr. F e l l Mrs. Crocker Mr. H a l l Mrs. Evans Mrs. Manville Mrs. Ogden 110 -1. Relative A b i l i t y of the Partners to Perceive Problems In the groups where the movement was retrograde, and there was no movement, the men perceived fewer problems, and of a less diverse nature than those perceived by t h e i r wives. Also, they presented the problems as being a r e s u l t of t h e i r wife's performance rather than t h e i r own. In the minimal movement group, and i n the group which achieved d i s t i n c t movement, most of the men perceived more numerous problems and of a more diverse nature, than those presented by t h e i r wives. , As opposed to the proceeding groups, these men were able to recognize, to some degree, t h e i r own r e s p o n s i b i l i t y i n the formation of the problems. Preston, Mudd and Froscher, i n the i r study regard-ing the factors which influence movement make t h i s comment: Movement i s generally negative or minimal for c l i e n t s who i n the f i r s t interview present t h e i r spouses i n an unfavourable l i g h t and who either accept a l l blame or put a l l blame on t h e i r partners for the marriage d i f f i c u l t i e s , rather than acknowledge that both are at fault. 1 2. Performance of the Husband i n the Masculine Role In the group of retrograde movement cases, the men were rated poor i n t h e i r performance i n the masculine r o l e i n most of the areas judged. They were considered to be poor i n a l l of the areas of emotional r e l a t i o n s h i p s . There were no "good" scores. There was a generally better performance i n the male r o l e by the men i n the group rated "no movement." 1 Preston, Mudd, and Froscher, S o c i a l Casework, p. 110. I l l -The majority of the ratings were l i m i t e d t w o scores of good occurred i n the group. The score of the group achieving minimal movement approximated that of the group of no move-ment cases. They were however, considered to be better economic providers. The men who achieved d i s t i n c t p o s i t i v e movement scored much better i n t h e i r performance i n the masculine r o l e . They a l l rated "good" both i n relationship to t h e i r children and as the economic provider of the family. Like the other groups however, they were f a i l i n g i n respect of t h e i r r e l a t i o n s h i p to t h e i r wives. 3. The Pattern of the Ma r i t a l Relationship (The Problem of Excessive Dependency This factor seemed relevant only i n that the pattern of a dependent husband and an aggressive wife occurred only i n groups of no movement and minimal movement. These men seemed to regard themselves as appendages to t h e i r wives, and i f she was p a r t i c i p a t i n g a c t i v e l y i n casework treatment, they were content to leave the r e s p o n s i b i l i t y f o r change with her. The degree of dependency on the wife seemed pertinent to movement. I f the husband could transfer some of t h i s dependency on the caseworker, a rel a t i o n s h i p seemed to develop. I f he persisted as seeing himself as dependent on his wife, and no other, t h i s did not occur. In some of these cases, the .aggressive wife was the one who u t i l i z e d casework services to e f f e c t change, and t h i s seemed more acceptable to both partners. ) - 112 -4. Ego Strength Both.of the men whose movement was retrograde, were considered psychotic. In one case the psychosis was confirmed by a p s y c h i a t r i s t ; i n the other i t was suspected by a p s y c h i a t r i s t . In the case of Mr. Brown who rated -2 move-ment, his deterioration seemed to be i n response to his wife's positive movement. This phenomena has often been noted i n casework with marriage partners, one of whom i s psychotic or pre-psychotic. That i s , as one gets better, the other gets worse. This also held i n the Nelson case, where Mrs. Nelson's movement was retrograde while her husband achieved positive movement. Among the no movement and minimal movement groups of cases, h a l f of the group were considered "poor" i n ego strength; h a l f were considered " l i m i t e d . " In the cases where the men achieved d i s t i n c t p ositive movement, a l l the men were rated " l i m i t e d " i n regard to ego strength. None of the men i n these f i f t e e n cases were rated as "good" i n regard to ego strength. 5. Willingness to Use Casework Service Generally the men who were placed i n the retrograde and no movement group were rated "poor." i n terms of t h e i r willingness to use the casework service. The men who achieved minimal positive movement, as a group, were more w i l l i n g to use the service. Three were rated " l i m i t e d " ; two were rated "good," and one rated "poor." A l l of the men who achieved d i s t i n c t p o s i t i v e movement were rated "good" i n willingness - 113 -to use the service. 6. The Partner who came F i r s t to the Agency In both cases, where there was retrograde movement on the part of the husbands, the wives came f i r s t to the agency to apply f o r service. In the group where there was no movement on the part of the husbands there_.were three eases i n which the wife came f i r s t to the agency, and l a t e r persuaded her husband to come i n . In the other case, both partners came together, having been referred by another agency. In the minimal movement group, there were four cases i n which the husband came f i r s t to the agency. In the other two cases both partners had been interested i n coming to the Family Service Agency, by another r e f e r r i n g agency. Where d i s t i n c t p o s i t i v e movement was achieved by the husbands, there was a v a r i a t i o n . In one case the husband came f i r s t , i n one case the wife came f i r s t , and i n the other case, both partners came together, being referred by another agency. There i s therefore, a s l i g h t i n d i c a t i o n that positive movement i s related to some extent, to the fac t of which partner applies to the agency for help. This was also indicated i n the study by Preston, Mudd and Froscher. They comment: "Movement i s also more l i k e l y to occur i n s e l f -referred c l i e n t s or i n cases referred by another professional person than i n eases i n which r e f e r r a l i s by another agency, - 114 -1 by the partner or by another private i n d i v i d u a l . " 7. Sex of the Worker The sex of the worker did not seem i n f l u e n t i a l i n the retrograde movement cases. One case was handled by a woman* one case was handled by a man. Both of these male c l i e n t s were so i l l that i t i s doubtful i f they could have related to a worker of either sex. Three of the four cases i n which no movement occurred on the part of the male partner were handled by female caseworkers. One was handled by a male caseworker. In none of these cases was a rel a t i o n s h i p established between the c l i e n t and the caseworker. In the minimal movement group there were four cases handled by male caseworkers; two were handled by a female caseworker. In one case handled by a female caseworker i t appeared quite obvious that the male c l i e n t could not have related to a male caseworker. (Jackson case.) In the other case handled by a female caseworker, i t became apparent, and was l a t e r confirmed, that the man should be seen by a male caseworker as a re l a t i o n s h i p with a woman provoked too much anxiety f o r him to handle. When th i s transfer was attempted, the c l i e n t withdrew. He achieved posi t i v e movement, +1. I f the case had been handled by a male caseworker he might have achieved more po s i t i v e movement. (Nelson case.) In the group where d i s t i n c t movement occurred, one 1 Preston, Mudd, and Froscher, S o c i a l Casework, pp. 108-109. - 115 -case was handled by a female caseworker; two by a male case-worker. In the case handled by the female worker, i t appeared that t h i s was appropriate to the c l i e n t ' s stage of development. The c l i e n t verbalized that he had no wish to talk to a man; " i n my experience i t i s always a woman who understands," he said. This man was able to derive support from a dependent rela t i o n s h i p with a woman; and with t h i s to effe c t changes i n his attitudes and s i t u a t i o n that rated a + 2 score i n regard to movement. Ideally, when he had been helped to a certai n l e v e l of performance, he could have been transferred to a male worker, i n order to give him a thera-peutic experience with an accepting male. Before this could be done, the c l i e n t withdrew; apparently because he.could not tolerate the competition with his wife, for the caseworker. (Ogden case.) I t i s apparent that i n t h i s small group there was more po s i t i v e movement i n the male partner among those cases handled by a male caseworker, rather than a female caseworker. 8. Rivalry Between the Spouses i n Regard to the Caseworker This did not seem to be a factor i n the retrograde movement and no movement groups. This i s to be expected as a relationship between the caseworker and c l i e n t did not develop. R i v a l r y between the spouses appeared i n four of the cases of the minimal movement group. In one case i t was handled by assigning the male partner to his own male case-worker. (Manville) In another case the Family Service Agency - 116 -caseworker worked with the male partner, and the main work with the female partner was carried on by the r e f e r r a l agency. (Jackson) In one case, periods of intensive interviews with the partners were staggered. (King) In one case the r i v a l r y was not handled early enough. When transfer of the male partner was attempted, he withdrew. (Nelson) In a l l of the cases of d i s t i n c t movement the element of r i v a l r y f o r the caseworker by the partners appeared, and had to be handled. In the two cases, F e l l and H a l l , periods of interviews with the partners were staggered by the male caseworker. In the H a l l case, an attempt was made to transfer the wife to a female caseworker but t h i s was unsuccessful, except f o r evaluation purposes. Later, a f t e r the husband had become more secure, the male caseworker continued interviews with the wife. In the Ogden case, staggered interview periods were not planned by the case-worker.. However, th i s was the way i t was handled by the partners themselves. The male partner verbalized t h i s by saying that "somehow he and his wife were vying f o r the case-worker's attention, and that when one was coming i n , i t was better i f the other did not." 9« Casework Techniques Used In the groups of retrograde movement and no movement, the casework techniques were primarily psychological support, - 117 -with some environmental modification. In a l l of the cases of minimal and d i s t i n c t movement, the technique of c l a r i f i c a -t i o n was used, i n addition to psychological support. In two cases environmental modification was also used. Thus i n a l l cases, i n t h i s group of p o s i t i v e move-ment, the technique of c l a r i f i c a t i o n was used i n addition to the supportive technique. The se l e c t i o n of techniques depends not only on the nature of the problem but on the c l i e n t ' s a b i l i t y to p r o f i t by the p a r t i c u l a r techniques, and the worker's a b i l i t y to use them. The vehicle for any technique i s the r e l a t i o n s h i p between c l i e n t and caseworker and, as has been pointed out, i n most of the cases where;: no movement occurred, the r e l a t i o n s h i p could not be established. 10 . Attitudes of Spouses to Each Other and to the Marriage The two men whose movement was retrograde, voiced a great deal of h o s t i l i t y toward th e i r spouses, and tended to see the c o n f l i c t i n the marriage as t h e i r wive's f a u l t . Mr. Brown wanted the marriage to continue but only on his terms. Mr. Daniel f e l t that the s i t u a t i o n was hopeless and "gave the marriage four years." In the group where there was no movement, a s i m i l a r attitude was evident. Mr. Able and Mr. Evans were very h o s t i l e to th e i r wives and f e l t that they had been shown no consideration by them. Mr. Able said he was determined to get a divorce; Mr. Evans continually threatened his wife that he intended to leave her i f "things didn't change." - 118 -Mr. Crocker denied that he and his wife ever quarrelled. Mr. Long f e l t the problem centered around h i s special needs which his wife could not meet. He wanted the marriage to continue, but f e l t he could not change his own behaviour and was doubtful that h i s wife would stay with him i f he did not. There was less verbalized h o s t i l i t y i n the male partners of the minimal movement group, i n regard to t h e i r wives. More need, i f not more overt desire, for the marriage to continue was verbalized. A l l of the three men who achieved d i s t i n c t p o s i t i v e movement had an intense need to preserve the marriage. Discussion of t h e i r spouse was h o s t i l e at times, but included some p o s i t i v e s . Further mention should be made of the paper presented at the National Conference of S o c i a l Work i n May, 1952, by Mrs. Emily H. Mudd, which dealt with t h i s subject. She was reporting on a study of the factors that influenced movement i n case records of married men and women who had been counselled i n connection with a marital problem. The - t research was based on the records of the Marriage Council of Philadelphia. The study referred to was part of a research program which, i t was hoped, would "lead to a complete v a l i d a t i o n of movement indices as well as provide useful knowledge about the factors that promote and i n h i b i t thera-1 peutic processes." 1 Preston, Mudd, and Froscher, S o c i a l Casework, p. 103. - 119 -This study y i e l d s exact information about the degree to which selected factors were found to be s i g n i f i c a n t i n r e l a t i o n to the movement i n the case records of 96 men and 115 women, a l l of whom had been counseled i n connection with a problem which arose a f t e r marriage. Factors that seemed to af f e c t the nature and degree of movement i n casework were grouped as (1) biographical; (2) s i t u a t i o n a l ; (3) counselling; (4) personality organization. 1) Biographical f a c t o r s , including age of c l i e n t , length of marriage, socio-economic status, r e l i g i o u s background, r e l i g i o u s a c t i v i t y , and education. 2) S i t u a t i o n a l f a c t o r s , including factors peculiar to the c l i e n t ' s problem and to the marriage r e l a t i o n s h i p . 3) Factors related to the counselling process, including the techniques of counselling used with the c l i e n t . 4) Factors related to the organization of the c l i e n t ' s personality. The case records were then examined by two teams of professionally trained persons, (mainly caseworkers, p s y c h i a t r i s t s , or psychologists) who made independent analyses, using a prescribed check l i s t . The r e s u l t s were then compared i n conference and disagreements were reconciled by further study of the case record. Although the authors point out that t h i s study represents only a beginning i n the study of the determinants of movement, the following were some of the general conclu-sions drawn. - 120 -1. The re s u l t s on the study of biographical factors point i n a f a m i l i a r d i r e c t i o n — c l i e n t s are people rather than s t a t i s t i c s . Age, education, and the other bases on which the population i s often f r a e t i o n -ized seem not to play any es s e n t i a l r o l e i n determining movement i n counseling. 2) The evidence points strongly i n the d i r e c t i o n of the fa c t that the determinants of movement are multiple and complex. In no case has any one determiner given c o r r e l a t i o n beyond the f o r t i e s , despite the f a c t that s p e c i f i c aspects of c l i e n t experience w i l l correlate as high as .80 with judged movement. 3) There i s some evidence to support the view that the setting of a permissive, encouraging atmosphere and relati o n s h i p i s the p r i n c i p a l l y h e l p f u l function of the counselor. 4 ) There i s substantial evidence to support the conclusion that, i f both marriage partners come f o r counseling, husbands and wives counseled separately and independently, although usually by the same counselor, move together; that i s , i f one improves, the other improves and i f one retrogresses the other retrogresses. This i s shown by the r e l a t i v e l y high correlations between those spouses who both come for counseling. As yet we have not studied i n t e n s i v e l y cases i n which only one partner comes f o r counseling. 1 This a r t i c l e i l l u s t r a t e s the complexity of the study of factors which influence movement i n casework, and indicates a course which can be followed by further research Into the subject. I t might be noted that i n thi s study carried out on the records of the Marriage Council of Philadelphia, the items to be expl'ored were known to the case-workers, and therefore, i t could be expected, would be more exactly noted i n the record than i s usually the case. In addition, schedules which were completed by the c l i e n t s , i n 1 Preston, Mudd, and Froscher, S o c i a l Casework, p. 111. 121 -regard to biographical items, and information about the marriage, were used to furnish further information. Since such items are often omitted inadvertently from records, such a device would seem important to a detail e d , accurate study of t h i s subject. CHAPTER 5 MARITAL CONFLICT: AN EXPLORATION OF TREATMENT ASSESSMENT METHODS The primary purpose of t h i s thesis has been exploratory: to examine the available data and to suggest methods of analysis and c l a s s i f i c a t i o n i n an important area of human w e l f a r e — m a r i t a l r e l a t i o n s . More concern i s being evidenced about the question of successful casework treatment of the husband i n marital c o n f l i c t cases. What sort of problems does he experience? Is he, as well as his wife, being reached by the casework treatment program? Some of the issues concerning caseworkers i n family agencies are whether i t i s e s s e n t i a l that both marriage partners be seen, and when th i s i s so, how treatment can best be handled i n terms of the method of involvement, the timing, and the assignment of caseworkers. Some of these issues have been c l a r i f i e d . Only a small number of cases which i l l u s t r a t e these problems were selected for t h i s study, (although a consider-able number were examined) because p r i n c i p l e s and l i n e s of exploration were more important at t h i s stage than an attempt at a representative or s t a t i s t i c a l cross-section. The cases were, however, divided into three groups, with f i v e cases i n each. In a l l cases both husband and wife were interviewed. These groups were: - 123 -Group I. Cases i n which the treatment plan was focussed mainly on casework with the wife. Group I I . Cases i n which the treatment plan was focussed mainly on casework with the husband. Group I I I . Cases i n which the treatment plan was focussed equally on casework with the husband and wife. The main objective of the thesis was to define c r i t e r i a for analyses of the various important components which might have affected these d i f f e r e n t degrees of focus on the husband, i n the handling of these cases. The performance of the husband i n the masculine r o l e was seen as one area requiring a n a l y s i s . Five c r i t e r i a were suggested, based on current source material. These were: 1) His performance as an emotional partner of the wife. 2) His performance as a sexual partner of the wife. 3) His performance as a father. 4) His performance as economic provider for the family. 5) His performance as a s o c i a l and c u l t u r a l standard sette r . Closely a l l i e d to t h i s question of the husband's ro l e i n the family group, i s the question of the sort of i n t e r -r e l a t i o n s h i p which exists between husband and wife. This matter was also studied i n these f i f t e e n cases, and f i v e basic patterns distinguished. These were: 1) Submissive husband, dominant wife. 2) Submissive wife, dominant husband. 3) One withdrawn mate, one demanding mate. 4) Both mates struggling f o r control. 5) Both mates excessively dependent. It i s important to add that there were no examples, among these cases, of a mature, interdependent rel a t i o n s h i p 124 -between husband and wife. There i s obviously l i t t l e l i k e l i h o o d of such people coming to family agencies for help with marital stress at the present stage of development and acceptance of such programs. As a broader conception of the service gains more acceptance i n the community, i t would seem l i k e l y that more cases would be handled of a less acute sort of marital discord. I t i s hardly necessary to emphasize that these two facets; the husband's performance i n the masculine r o l e , and the basis of the i n t e r r e l a t i o n s h i p between him and his wife, would be basic to the understanding of any marital c o n f l i c t case. When an assessment of the women's performance i n her feminine r o l e i s added to t h i s , a clear picture of the marriage would emerge, with both i t s g r a t i f i c a t i o n s and c o n f l i c t s , i t s comparative degrees of health and neurosis. A l l of the f i f t e e n men studied i n these cases, were f a i l i n g to perform adequately i n the emotional areas of t h e i r roles i n the family group. While most of them performed adequately as f a r as th e i r l i f e external to the family was concerned, they were f a i l i n g both to g r a t i f y , and t o f i n d g r a t i f i c a t i o n s i n t h e i r relationships to th e i r wife and children. I t would appear that most of them were clear about t h e i r need to provide economically f o r t h e i r f a m i l i e s , and to conform to external socio-economic standards. They appeared to accept t h i s r e s p o n s i b i l i t y and struggled to perform i n these areas. This seemed to give them some f e e l i n g of - 125 -adequacy and w o r t h , w h i c h s u s t a i n e d them i n s p i t e o f c o n s i d e r a b l e i n s e c u r i t y i n t h e m a r i t a l r e l a t i o n s h i p . T h e i r i n a b i l i t y t o p e r f o r m i n the e m o t i o n a l a r e a s i n a mature way, was s i g n i f i c a n t when viewed i n r e l a t i o n t o t h e i r h i s t o r i e s . Most o f t h e s e men had e x p e r i e n c e d t r a u m a t i c r e l a t i o n s h i p s i n c h i l d h o o d , w i t h e i t h e r f a t h e r o r mother, o r b o t h . T h e i r p a r e n t s had been p e o p l e who th e m s e l v e s had e x p e r i e n c e d d i f f i c u l t y i n t h e i r s e x u a l i d e n t i f i c a t i o n s . Thus t h e male c l i e n t , g e n e r a l l y , had n o t had an o p p o r t u n i t y t o s u c c e s s f u l l y work t h r o u g h the o e d i p a l s i t u a t i o n , and t o a c c e p t and i n t e g r a t e s t a n d a r d s f rom a mature male f i g u r e . C o n s i d e r i n g t h e f a c t t h a t elements o f a c o n t i n u i n g o e d i p a l c o n f l i c t were p r e s e n t i n most o f t h e s e c l i e n t s , i t becomes a p p a r e n t t h a t i n each c a s e , t h e sex o f t h e caseworker a s s i g n e d t o work w i t h them on an i n t e n s i v e b a s i s s h o u l d have been c a r e f u l l y c o n s i d e r e d . The assignment s h o u l d have been made on a d i a g n o s t i c f o r m u l a t i o n o f the c l i e n t ' s s t a g e of e m o t i o n a l development, r a t h e r t h a n on t h e r o u t i n e b a s i s used. Such a way o f w o r k i n g would demand a g r e a t d e a l of f l e x i b i l i t y i n agency s t r u c t u r e r e g a r d i n g t h e assignment o f c a s e s , but might w e l l be e c o n o m i c a l i n terms o f more e f f e c t i v e casework. I f t h e casework i s t o be on a f a i r l y i n t e n s i v e l e v e l , i t i s l i k e l y t h a t t h e r e l a t i o n s h i p between t h e c l i e n t and °worker w i l l be a deep one, c o n t a i n i n g elements of t r a n s f e r e n c e w h i c h may a i d or d e t e r t r e a t m e n t . I n such c a s e s , i t i s - 126 -important that the c l i e n t ' s feelings about h i s parents and his i d e n t i f i c a t i o n s with them be considered, as he w i l l tend to project these feelings onto the caseworker. Since negative transference elements must be kept to a minimum i f casework help i s to be e f f e c t i v e , i t would seem best.for the c l i e n t to be assigned to a caseworker of the same sex as the parent with whom the c l i e n t experienced the most security, or the parent with whom he i s struggling to i d e n t i f y . In considering the assignment of the male c l i e n t , much depends on the stage he has achieved i n the resolution of his oedipal feelings about h i s father and mother. There should also be enough f l e x i b i l i t y to allow transfer of a c l i e n t from the worker of one sex to a worker of the opposite sex, when t h i s would afford the c l i e n t an opportunity for a further growth-producing experience. For instance, a male c l i e n t who had, i n the main, found most of his s a t i s f a c t i o n s i n hi s r e l a t i o n s h i p with his mother, and had been unable to resolve his feelings about his father through i d e n t i f i c a t i o n with him, might f i n d , i n the beginning, a relationship with a male caseworker too threatening. However, when he had been helped to a ce r t a i n stage of security by a female caseworker, he might then be able to move into a therapeutic experience with a male caseworker, who would function as an accepting father person. The practice now seems to be that the caseworker to whom the case i s assigned, interviews both marriage partners, - 127 -unless there are strong contra-indications. I f intensive casework i s planned with both, the element of r i v a l r y between the spouses for the caseworker must be given consideration, and, i f indicated, an early d i v i s i o n of the case effected. Except i n a few of the cases, t h i s was not done. It must be borne i n mind that both the husband and wife i n marital c o n f l i c t probably have r e s i d u a l , unmet emotional needs which were not g r a t i f i e d by the parents. I f the case-work relat i o n s h i p i s deep and transference elements present, feelings which the c l i e n t once had about the parents may be reactivated. This makes i t very d i f f i c u l t f o r the c l i e n t to share, with the spouse, the r e l a t i o n s h i p to the caseworker. I t would appear that a decision regarding the case being handled by one caseworker or two, should be c a r e f u l l y made i n each case, i f intensive work i s planned with both marriage partners. Excessive emotional dependency on the part of the men seemed to be the most frequent emotional problem. I f a relationship could be developed with the c l i e n t , the case-worker was able to u t i l i z e these dependency needs i n treatment. When the c l i e n t was not able to transfer some of his dependency needs to the worker, he continued to seek g r a t i f i c a -t i o n , u n r e a l i s t i c as i t might be, from the spouse. In such cases, casework had to be planned with the spouse. None of these men seem to have handled t h e i r dependency needs with - 128 -much maturity. It was s t r i k i n g that t h i s sample of cases lacked any example of a man with a strong, secure, masculine i d e n t i f i c a t i o n . One may speculate as to whether, i n Western culture, such men do not avoid contact with s o c i a l agencies, or indeed any source which treats "emotional problems." Concern with such matters and discussion of intimate emotional relationships might seem incompatible to them, with t h e i r concept of what represents masculinity. Perhaps, too, the t r a d i t i o n a l s t a f f i n g of s o c i a l agencies by women, and the oft encountered attitude of wives that they are invoking the authority of "the welfare" against t h e i r husbands, has done l i t t l e to assure the masculine c l i e n t of a welcome from such agencies. I t would seem important that the s t a f f of an agency which works with marital counselling cases have an appropriate balance i n number of male and female workers. Also, in t e r p r e t a -t i o n of the program to the public should be balanced In regard to t h i s aspect of male p a r t i c i p a t i o n i n marital counselling. Considering the p o s s i b i l i t y again, that wives sometimes seek marital counselling as an attempt to control or threaten t h e i r husbands; and perhaps have given this punitive i n t e r p r e t a t i o n to the spouse, i t i s unfortunate that most of the caseworker's attempts to involve the male partner were carried out through the wife. I t would seem better that a di r e c t approach to the male partner be made by the caseworker, so that a correct i n t e r p r e t a t i o n can be given. In so doing, - 129 -t h e caseworker a l s o i n d i c a t e s i n t e r e s t i n t h e husband as a p e r s o n i n h i s own r i g h t . The t i m i n g o f t h e i n v o l v e m e n t o f t h e second p a r t n e r i s a l s o an i n t e r e s t i n g q u e s t i o n . Some s o u r c e m a t e r i a l i n d i c a t e s i t i s i m p o r t a n t t o i n v o l v e t h e second p a r t n e r as soon as p o s s i b l e , a f t e r t h e f i r s t has been seen. Other a u t h o r i t i e s h o l d t h a t i t i s i m p e r a t i v e t o form a r e l a t i o n s h i p w i t h t h e p a r t n e r who f i r s t a p p l i e s f o r h e l p b e f o r e an attempt i s made t o i n v o l v e the second. I n a l l o f t h e cases s t u d i e d , i t appeared the caseworkers had moved t o i n v o l v e t h e second p a r t n e r as soon as p o s s i b l e . I t i s t r u e t h a t i n some o f t h e cases t h e r e was p r e s s u r e from t h e f i r s t p a r t n e r f o r t h i s t o be done; but t h e r e was no attempt by t h e casew o r k e r s t o p r e v e n t t h i s h a p p e n i n g . Some thought might be g i v e n t o t h e i m p l i c a t i o n s o f t h i s r e a d i n e s s t o i n v o l v e t h e second p a r t n e r The caseworker i s n o t y e t ..sure o f t h e a b i l i t y o f t h e f i r s t p a r t n e r t o use t h e casework s e r v i c e ; t h e r e has n o t y e t been time t o f o r m u l a t e a d i a g n o s t i c p i c t u r e o f the f i r s t c l i e n t ' s d i f f i c u l t i e s . The f i r s t c l i e n t may, w i t h o u t the s u p p o r t o f a r e l a t i o n s h i p w i t h the c a s e w o r k e r , be i n s e c u r e enough o r u n c o n s c i o u s l y m o t i v a t e d t o d i s t o r t t h e f a c t s p r e s e n t e d t o the c a s e w o r k e r , i n r e g a r d t o h e r own c o n t r i b u t i o n t o t h e m a r r i a g e d i f f i c u l t i e s . I f the spouse i s i n v o l v e d t o o soon, and t h e element o f r i v a l r y i n t r o d u c e d , she may w e l l f i n d i t d i f f i c u l t , i f n o t i m p o s s i b l e t o ever do s o . Then t o o , a c e r t a i n amount o f p r o j e c t i o n may be p r e s e n t i n t h e f i r s t - 130 -parnter's account of the marriage problem. I f the caseworker moves immediately to involve the second partner, t h i s may be taken as an i n d i c a t i o n that the caseworker sees the partner at f a u l t , and reinforce the f i r s t partner's defense of projection. In any case i t places the caseworker into contact with both partners, presumably offering casework service to both, before a diagnostic understanding of either c l i e n t has been reached and a l l the facets of treatment planning considered. On the other hand, the partner not involved may f e e l l e f t out. Also, seeing both partners may give a clearer picture of the t o t a l s i t u a t i o n . Each marital c o n f l i c t case presents a d i f f e r e n t problem and each must be weighed separately i n regard to the involvement of the second partner, and when i t should occur. In those cases where the treatment was mainly carried out with one partner, i t i s in t e r e s t i n g to note the relati o n s h i p between which c l i e n t came f i r s t to the agency, and the focus of treatment. In Group I, where the focus was on the wife, i n four cases out of f i v e , the wife was the person who applied to the agency for service, and an attempt was made to involve the husband l a t e r . In the f i f t h case, the husband and wife came f o r the f i r s t interview together; but i t was obviously at the wife's insistence. In Group I I , where the focus was on the husband, i n four cases out of f i v e , the husband applied for service, and the wife was involved l a t e r . - 131 -The sex of the worker would also seem to have some rela t i o n s h i p to the focus on one partner or the other. In Group I, where the casework was primarily carried out with the wives, four of the caseworkers were women. In the f i f t h case the wife had requested a male caseworker be assigned. In Group I I , where the men might be considered to have been the primary c l i e n t s , the casework was ca r r i e d out, i n four cases, by a male caseworker. In the f i f t h case, there was no question of which partner would be the focus, as ease-work was being offered to the wife by another agency; which was the treatment plan formulated i n conference by the two agencies. The focus of treatment i n these three groups also seems related to the r e l a t i v e t r e a t a b i l i t y of the marriage partners. However, one of the c r i t e r i a used.in t h i s study for t r e a t a b i l i t y was "willingness to use the service." I t seems probable that t h i s willingness was, i n turn, affected by the f a c t of which partner applied for help f i r s t , and the sex of the worker assigned to handle the case. The treatment methods used were predominately those of psychological support and c l a r i f i c a t i o n . A tendency to stress c l a r i f i c a t i o n was noted i n the recording, although perhaps not present i n the actual interviews, whenever the c l i e n t appeared able to use t h i s . While there i s no doubt of the value of increased understanding of his problem by the c l i e n t , i t i s also important that the caseworker o f f e r a - 132 -therapeutic r e l a t i o n s h i p to those c l i e n t s who can use i t . This unspoken, emotional component of the learning experience i s something the caseworker i s uniquely able to o f f e r the c l i e n t . An important implication i s that more information about the kind of r e l a t i o n s h i p developed between the case-worker and c l i e n t , as well as the use made of i t , by the c l i e n t , should be included i n the recording. This study shows an improvement i n the marital relationship to be possible, i r r e s p e c t i v e of the focus on the wife, the husband, or both marriage partners. However, i n a l l cases both partners were seen by the caseworker more than once. A study using a control group i n which only one partner was seen, comparing i t to a group i n which both partners p a r t i c i -pated equally i n treatment, i s an obvious next step i n research. In most cases where there was considerable improve-ment i n the marriage r e l a t i o n s h i p , p o s i t i v e movement had been achieved by both marriage partners. This indicates that a higher degree of improvement might be expected i f both partners co-operate well i n treatment. In turn, t h i s i s dependent on many factors regarding the pers o n a l i t i e s of the marriage partners, the sort of rela t i o n s h i p between them, the s k i l l of the caseworker, and agency structure. I t i s possible however, to a f f e c t some improvement i n the marriage i f only one partner achieves p o s i t i v e movement. - 133 -I t seems that there can be no d o c t r i n a i r e approach to treatment planning with the two marriage partners. A plan which might augur considerable improvement i n one case, might be quite i n e f f e c t i v e i n another. In t h i s area, as i n casework generally, each case must be considered c a r e f u l l y , weighing a l l of the factors possible, with the treatment plan being t a i l o r e d to the needs of the c l i e n t s and t h e i r i n d i -vidual a b i l i t y to use the casework service. The purpose of t h i s study was to explore the r o l e of the male partner i n marital c o n f l i c t cases, and the plan-ning of the caseworker i n regard to the husband's p a r t i c i p a t i o n i n treatment. The study has raised questions which should merit consideration by the caseworker i n formulating the plan of treatment i n such cases; i t also indicates some of the factors which may act as deterrents to the successful case-work involvement of the male partner. 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Thesis/Dissertation
eng
Social Work
Vancouver : University of British Columbia Library
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Graduate
The psychodynamics and treatment of the male partner in marital conflict cases : an exploratory study based on Family Service Agency files, Vancouver, 1957
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